Basic Information
| Provider Information | |||||||||
| NPI: | 1336768530 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BOEHM | ||||||||
| FirstName: | STEVEN | ||||||||
| MiddleName: | WILLIAM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 205 SOUTH FRONT STREET | ||||||||
| Address2: | BRADY 916 | ||||||||
| City: | HARRISBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 17104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172318755 | ||||||||
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| Practice Location | |||||||||
| Address1: | 205 SOUTH FRONT STREET | ||||||||
| Address2: | BRADY 916 | ||||||||
| City: | HARRISBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 17104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172318755 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/09/2020 | ||||||||
| LastUpdateDate: | 08/11/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/11/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | OT019872 | PA | N | Allopathic & Osteopathic Physicians | Surgery | 390200000X | OT019872 | PA | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.