1144226606 NPI number — KENNETH J BOYD M.D.

Table of content: KENNETH J BOYD M.D. (NPI 1144226606)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144226606 NPI number — KENNETH J BOYD M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOYD
Provider First Name:
KENNETH
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144226606
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/14/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1088 W BALTIMORE PIKE
Provider Second Line Business Mailing Address:
STE 2101
Provider Business Mailing Address City Name:
MEDIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19063-5136
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-565-3435
Provider Business Mailing Address Fax Number:
610-566-1387

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1088 W BALTIMORE PIKE
Provider Second Line Business Practice Location Address:
STE 2101
Provider Business Practice Location Address City Name:
MEDIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19063-5136
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-565-3435
Provider Business Practice Location Address Fax Number:
610-566-1387
Provider Enumeration Date:
06/21/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208C00000X , with the licence number:  MD036083E , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0011209700002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 32129B . This is a "KEYSTONE MERCY HEALTH PLA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 280000253 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0031097000 . This is a "INDEPENDENCE BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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