Basic Information
| Provider Information | |||||||||
| NPI: | 1952344384 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BOOS | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | C. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 280 CHESTNUT ST FL 2 | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 011991001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4137945700 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 300 CAREW STREET | ||||||||
| Address2: | STE 2 | ||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 011042146 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4137949816 | ||||||||
| FaxNumber: | 4137944945 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2006 | ||||||||
| LastUpdateDate: | 04/09/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | D0059645 | MD | N | Allopathic & Osteopathic Physicians | Pediatrics | 2080C0008X | 238099 | MA | Y | Allopathic & Osteopathic Physicians | Pediatrics | Child Abuse Pediatrics | 208000000X | 169534-1 | NY | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | 0101241902 | VA | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | 238099 | MA | N | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 1952344384 | 05 | VA | MEDICAID | 4052994 00 | 05 | MD | MEDICAID | 1952344384 | 05 | MA | MEDICAID |