Healthcare Provider Details
I. General information
NPI: 1124080247
Provider Name (Legal Business Name): STEPHANIE ANNE BOYARSKY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y
II. Dates (important events)
Enumeration Date: 04/04/2006
Last Update Date: 03/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
1789 N KEYSER AVE
SCRANTON PA
18508-1250
US
IV. Provider business mailing address
1789 N KEYSER AVE
SCRANTON PA
18508-1250
US
V. Phone/Fax
- Phone: 570-969-1904
- Fax: 570-207-5314
- Phone: 570-969-1904
- Fax: 570-207-5314
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 207Q00000X |
| Taxonomy | Family Medicine Physician |
| License Number | MD042647L |
| License Number State | PA |
VII. Legacy identifiers
For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:
| # 1 | |
| Identifier | 0461081000 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | PABLUE CROSS |
| # 2 | |
| Identifier | 080070777 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | RAILROADMEDICARE |
| # 3 | |
| Identifier | 631143 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | FIRST PRIORITY LIFE |
| # 4 | |
| Identifier | 001468 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | FIRST PRIORITY HEALTH HMO |
| # 5 | |
| Identifier | 001290633 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | UNITED |
| # 6 | |
| Identifier | 2Y2168 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | HEALTH AMERICA |
| # 7 | |
| Identifier | 27539 E475 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | GGOLD |
| # 8 | |
| Identifier | 27539 E475 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | GHP |
| # 9 | |
| Identifier | 631143 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | PA BLUE SHIELD |
| # 10 | |
| Identifier | 536762 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | AETNA |
| # 11 | |
| Identifier | 0012220210002 |
| Identifier Type | MEDICAID |
| Identifier State | PA |
| Identifier Issuer | |
| # 12 | |
| Identifier | 0461081000 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | BPC |
| # 13 | |
| Identifier | 27539 E475 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | GEISINGER HEALTH/990LD 9H |
| # 14 | |
| Identifier | E59863 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | STERLING |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone:
