Basic Information
| Provider Information | |||||||||
| NPI: | 1285619155 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BOERSTLING | ||||||||
| FirstName: | HERBERT | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 147 MILK ST | ||||||||
| Address2: | PROVIDER ENROLLMENT - 9TH FLOOR | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021094806 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6175598053 | ||||||||
| FaxNumber: | 6174213487 | ||||||||
| Practice Location | |||||||||
| Address1: | 333 LONGWOOD AVE | ||||||||
| Address2: | CHILDREN'S HOSPITAL | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021155711 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6173558732 | ||||||||
| FaxNumber: | 6172778934 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/13/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 31636 | MA | X | Allopathic & Osteopathic Physicians | Pediatrics | 208M00000X | 31636 | MA | X | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | PP104 | 01 | MA | HARVARD PILGRIM HEALTH | OTHER | B11441 | 01 | MA | BLUE CROSS | OTHER | 0023650 | 01 | MA | NEIGHBORHOOD HEALTH PLAN | OTHER | 0130699 | 05 | MA | MEDICAID | 031636 | 01 | MA | TUFTS HEALTH PLAN | OTHER | 8090525-002 | 01 | MA | CIGNA | OTHER |