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NPI Code Detail

MEDICARE: DR. MICHELLE DELORES BOOSE M.D., M.P.H.

MEDICARE: DR. MICHELLE DELORES BOOSE M.D., M.P.H.
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
1207Q00000XFamily Medicine Physician2015-01035NC
2207Q00000XFamily Medicine Physician35095053OH
3207Q00000XFamily Medicine Physician0101258063VA

General Provider Information

NPI Number : 1922268978
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MICHELLE DELORES BOOSE M.D., M.P.H.
Provider Business Mailing Address
First Line : PO BOX 60447
Second Line :
City : CHARLOTTE
State : NC
Zip : 28260-0447
Country : US
Telephone Number :
Fax Number : 828-232-2942
Provider Business Practice Location Address
First Line : 2610 W ARROWOOD RD
Second Line :
City : CHARLOTTE
State : NC
Zip : 28273-6134
Country : US
Telephone Number : 704-316-1700
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/12/2008
Last Update Date : 12/09/2025

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