1528014909 NPI number — MARK E. BOYKIW, M.D.

Table of content: (NPI 1528014909)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528014909 NPI number — MARK E. BOYKIW, M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARK E. BOYKIW, M.D.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1528014909
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
841 HOSPITAL ROAD
Provider Second Line Business Mailing Address:
SUITE 3100
Provider Business Mailing Address City Name:
INDIANA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15701
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-349-3170
Provider Business Mailing Address Fax Number:
724-349-3410

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
841 HOSPITAL RD
Provider Second Line Business Practice Location Address:
SUITE 3100
Provider Business Practice Location Address City Name:
INDIANA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15701-3620
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-349-3170
Provider Business Practice Location Address Fax Number:
724-349-3410
Provider Enumeration Date:
05/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BOYKIW
Authorized Official First Name:
MARK
Authorized Official Middle Name:
E
Authorized Official Title or Position:
SOLE PROPRIETOR
Authorized Official Telephone Number:
724-349-3170

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  MD021715E , 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: 0008638910003 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 252167 . This is a "UPMC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 8169517 . This is a "CIGNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1503139 . This is a "GATEWAY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1277920 . This is a "FUNDS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5479306 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com