Healthcare Provider Details

I. General information

NPI: 1154479749
Provider Name (Legal Business Name): RICHARD N BOYAJIAN ANP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 02/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 FRANCIS ST L205
BOSTON MA
02115-6110
US

IV. Provider business mailing address

75 FRANCIS ST L205
BOSTON MA
02115-6110
US

V. Phone/Fax

Practice location:
  • Phone: 617-525-9422
  • Fax: 617-394-2979
Mailing address:
  • Phone: 617-525-9422
  • Fax: 617-394-2979

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0200X
TaxonomyOncology Registered Nurse
License Number200839
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: