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General NPI Number Information
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NPI Number | 1659532935
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Entity Type | Individual
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Provider Name | KATHLEEN MARY BOYLE DO
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Gender | Female
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Dates
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Enumeration Date | 06/19/2008
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Last Update Date | 10/23/2017
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Provider Practice Location Address
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Address Line | 8340 LAKEWOOD RANCH BLVD STE 210
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City | LAKEWOOD RANCH
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State | FL
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Zip | 34202-5185
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Country | US
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Telephone | 941-782-2800
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Fax | 941-782-2513
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Provider Business Mailing Address
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Address Line | 367 S GULPH ROAD ATTN. IPM CREDENTIALING
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City | KING OF PRUSSIA
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State | PA
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Zip | 19406-3121
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Country | US
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Telephone | 610-382-4943
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Fax | 610-878-3965
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | OS12961
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | OS014325
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License Number State | PA
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