Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | SC001840L | PA |
NPI | 1083686034 |
---|---|
Provider Name | Stanley D Bosta |
First Address | Homestead, PA 15120-1140 |
Second Address | Homestead, PA 15120-1140 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/02/2006 |
Last Update Date | 15/01/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0004303232 | AETNA PIN (01) | PA |
0005069140004 | (05) | PA |
1015184 | GATEWAY HMO PROV NUMBER (01) | PA |
1156610001 | DMERC PROVIDER NUMBER (01) | PA |
1205011277 | DMERC NPI (01) | PA |
1382437 | HIGHMARK GROUP NUMBER (01) | PA |
1710912845 | GROUP NPI (01) | PA |
1710912845 | RR MEDICARE GROUP NPI (01) | PA |
63793 | HIGHMARK INDIVIDUAL PROV# (01) | PA |
T28060 | (02) | PA |