MEDICARE: SOHEIR BOSHRA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	0101-235582	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1750365813
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SOHEIR BOSHRA MD

Provider Business Mailing Address
First Line	:	PO BOX 95460
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44101-0033
Country	:	US
Telephone Number	:	602-581-6076
Fax Number	:	602-263-1619

Provider Business Practice Location Address
First Line	:	2001 CRYSTAL SPRING AVE SW
Second Line	:	SUITE 302
City	:	ROANOKE
State	:	VA
Zip	:	24014-2462
Country	:	US
Telephone Number	:	540-981-7653
Fax Number	:	540-981-7469

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/02/2005
Last Update Date	:	02/17/2026

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Directions to “ SOHEIR BOSHRA MD” Practice Location

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