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1962402107

NPI Code Detail

MEDICARE: BARRY BOSTON MD

MEDICARE: BARRY BOSTON 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	207RH0003X	Hematology & Oncology Physician	10091	TN
2	207RH0003X	Hematology & Oncology Physician	16847	MS

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	4020364	OTHER		AETNA
3	2004579	OTHER	TN	BLUE CROSS BLUE SHIELD
4	2694685	OTHER		CIGNA
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	119722	OTHER		BETTER HEALTH TNCARE
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	3000094	OTHER		TLC TNCARE

General Provider Information

NPI Number	:	1962402107
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BARRY BOSTON MD

Provider Business Mailing Address
First Line	:	7945 WOLF RIVER BLVD
Second Line	:	SUITE 300
City	:	GERMANTOWN
State	:	TN
Zip	:	38138-1762
Country	:	US
Telephone Number	:	901-767-4520
Fax Number	:	901-684-2515

Provider Business Practice Location Address
First Line	:	7945 WOLF RIVER BLVD
Second Line	:	SUITE 300
City	:	GERMANTOWN
State	:	TN
Zip	:	38138-1762
Country	:	US
Telephone Number	:	901-767-4520
Fax Number	:	901-684-2515

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

Provider Enumeration Date	:	07/29/2005
Last Update Date	:	10/05/2009

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Directions to “ BARRY BOSTON MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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