Healthcare Provider Details

I. General information

NPI: 1245460054
Provider Name (Legal Business Name): THERESA MARIA BOYD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2009
Last Update Date: 07/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2041 GEORGIA AVE NW DEPT OF PATHOLOGY
WASHINGTON DC
20060-0001
US

IV. Provider business mailing address

2041 GEORGIA AVE NW DEPT OF PATHOLOGY
WASHINGTON DC
20060-0001
US

V. Phone/Fax

Practice location:
  • Phone: 202-865-1353
  • Fax:
Mailing address:
  • Phone: 202-865-1353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZB0001X
TaxonomyBlood Banking & Transfusion Medicine Physician
License Number17394
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: