=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528014909
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MARK E. BOYKIW, M.D.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/26/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 841 HOSPITAL RD SUITE 3100
-----------------------------------------------------
City | INDIANA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15701-3620
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-349-3170
-----------------------------------------------------
Fax | 724-349-3410
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 841 HOSPITAL ROAD SUITE 3100
-----------------------------------------------------
City | INDIANA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-349-3170
-----------------------------------------------------
Fax | 724-349-3410
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SOLE PROPRIETOR
-----------------------------------------------------
Name | MARK E BOYKIW
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 724-349-3170
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | MD021715E
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------