1376735266 NPI number — DR. ROY JUSTIN BOYD PH.D.; PSYCHOLOGIST

Table of content: DR. ROY JUSTIN BOYD PH.D.; PSYCHOLOGIST (NPI 1376735266)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376735266 NPI number — DR. ROY JUSTIN BOYD PH.D.; PSYCHOLOGIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOYD
Provider First Name:
ROY
Provider Middle Name:
JUSTIN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D.; PSYCHOLOGIST
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:
1376735266
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/06/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9810 PATUXENT WOODS DR
Provider Second Line Business Mailing Address:
SUITE K
Provider Business Mailing Address City Name:
COLUMBIA
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21046-1595
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
443-923-7755
Provider Business Mailing Address Fax Number:
410-309-1573

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9810 PATUXENT WOODS DR
Provider Second Line Business Practice Location Address:
SUITE K
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21046-1595
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
443-923-7755
Provider Business Practice Location Address Fax Number:
410-309-1573
Provider Enumeration Date:
08/14/2007

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: 101Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103T00000X , with the licence number: 05187 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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