Healthcare Provider Details

I. General information

NPI: 1447290911
Provider Name (Legal Business Name): ANISSA BOYLE PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 03/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 SAINT PAUL ST MERCY MEDICAL CENTER
BALTIMORE MD
21202-2102
US

IV. Provider business mailing address

301 SAINT PAUL ST MERCY MEDICAL CENTER
BALTIMORE MD
21202-2102
US

V. Phone/Fax

Practice location:
  • Phone: 410-332-9036
  • Fax:
Mailing address:
  • Phone: 410-332-9036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA052100
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC0003683
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: