Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | MT197442 | PA |
Y | 208600000X | Surgeon | MT197442 | PA |
N | 2086S0120X | Pediatric Surgery | 25MA10642700 | NJ |
N | 2086S0120X | Pediatric Surgery | MT197442 | PA |
NPI | 1114157419 |
---|---|
Provider Name | Dr. Matthew Mikhail Boelig |
First Address | Rockland, DE 19732-0191 |
Second Address | Wilmington, DE 19803 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2009 |
Last Update Date | 06/11/2019 |