Provider Demographics
NPI:1548487259
Name:BOSLOW, JUDY L (MD)
Entity type:Individual
Prefix:
First Name:JUDY
Middle Name:L
Last Name:BOSLOW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 POST RD
Mailing Address - Street 2:SUITE SUITE 1L
Mailing Address - City:SOUTHPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06890-1258
Mailing Address - Country:US
Mailing Address - Phone:203-254-3886
Mailing Address - Fax:203-254-3872
Practice Address - Street 1:2600 POST RD
Practice Address - Street 2:SUITE SUITE 1L
Practice Address - City:SOUTHPORT
Practice Address - State:CT
Practice Address - Zip Code:06890-1258
Practice Address - Country:US
Practice Address - Phone:203-254-3886
Practice Address - Fax:203-254-3872
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2013-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT036058207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
160001766Medicare ID - Type Unspecified
G48926Medicare UPIN