Healthcare Provider Details

I. General information

NPI: 1255694378
Provider Name (Legal Business Name): MARIA THERESA BOYLAN D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2012
Last Update Date: 09/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52 HIGH ST ELLIOT FAMIY MEDICINE AT NEW BOSTON
NEW BOSTON NH
03070-4027
US

IV. Provider business mailing address

52 HIGH ST ELLIOT FAMIY MEDICINE AT NEW BOSTON
NEW BOSTON NH
03070-4027
US

V. Phone/Fax

Practice location:
  • Phone: 603-487-3429
  • Fax: 603-487-2103
Mailing address:
  • Phone: 603-487-3429
  • Fax: 603-487-2103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number17100
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: