Healthcare Provider Details

I. General information

NPI: 1366362378
Provider Name (Legal Business Name): MITCHELL RILEY BOYLE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MITCH BOYLE

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

524 N PROVIDENCE RD
MEDIA PA
19063-3056
US

IV. Provider business mailing address

2 WATERVIEW RD APT B09
WEST CHESTER PA
19380-6353
US

V. Phone/Fax

Practice location:
  • Phone: 484-440-9416
  • Fax:
Mailing address:
  • Phone: 610-427-0748
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: