Healthcare Provider Details

I. General information

NPI: 1811164957
Provider Name (Legal Business Name): DENIS A. BOYLE JR MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2008
Last Update Date: 04/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 LONG LN
UPPER DARBY PA
19082-3112
US

IV. Provider business mailing address

111 LONG LN
UPPER DARBY PA
19082-3112
US

V. Phone/Fax

Practice location:
  • Phone: 610-352-7816
  • Fax: 610-352-1423
Mailing address:
  • Phone: 610-352-7816
  • Fax: 610-352-1423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number039006L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number039066L
License Number StatePA

VIII. Authorized Official

Name: DR. DENIS A BOYLE JR.
Title or Position: MEDICAL DOCTOR
Credential: MD
Phone: 610-352-7816