Healthcare Provider Details

I. General information

NPI: 1063856391
Provider Name (Legal Business Name): ELAINE CHUNG BOYD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2013
Last Update Date: 04/05/2022
Certification Date: 04/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5655 HUDSON DR STE 130
HUDSON OH
44236-4454
US

IV. Provider business mailing address

333 TIMBER RUN DR
CANFIELD OH
44406-7623
US

V. Phone/Fax

Practice location:
  • Phone: 330-655-3840
  • Fax: 330-655-3845
Mailing address:
  • Phone: 937-422-9318
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35.129187
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: