Healthcare Provider Details

I. General information

NPI: 1427336817
Provider Name (Legal Business Name): MARY NEELEY BOYCE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2011
Last Update Date: 09/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 SHOREWAY DR STE 120
QUEENSTOWN MD
21658-1681
US

IV. Provider business mailing address

7580 BUCKINGHAM BLVD STE 200
HANOVER MD
21076-3210
US

V. Phone/Fax

Practice location:
  • Phone: 410-827-4001
  • Fax: 410-827-4333
Mailing address:
  • Phone: 410-729-5140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC006881
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0010-02843
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: