Provider Demographics
NPI:1235117219
Name:BOERSMA, DAVID P (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:P
Last Name:BOERSMA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7505 OSLER DR STE 510
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-7740
Mailing Address - Country:US
Mailing Address - Phone:410-823-5532
Mailing Address - Fax:410-823-5703
Practice Address - Street 1:7505 OSLER DR
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-7736
Practice Address - Country:US
Practice Address - Phone:410-823-5532
Practice Address - Fax:410-823-5703
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-09
Last Update Date:2007-08-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0040048207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDE58561Medicare UPIN
MD372RMedicare ID - Type Unspecified