Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | ||
N | 222Z00000X | Podiatrist | ||
Y | 224P00000X | Prosthetist |
NPI | 1164963880 |
---|---|
Provider Name | Justin Michael Boehm |
First Address | Silver Spring, MD 20910-1230 |
Second Address | Silver Spring, MD 20910-1230 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2017 |
Last Update Date | 14/03/2017 |