MEDICARE: KENNETH J BOYD M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208C00000X	Colon & Rectal Surgery Physician	MD036083E	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	280000253	OTHER	PA	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	32129B	OTHER	PA	KEYSTONE MERCY HEALTH PLA
4	0031097000	OTHER	PA	INDEPENDENCE BLUE CROSS

General Provider Information

NPI Number	:	1144226606
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH J BOYD M.D.

Provider Business Mailing Address
First Line	:	1088 W BALTIMORE PIKE
Second Line	:	STE 2101
City	:	MEDIA
State	:	PA
Zip	:	19063-5136
Country	:	US
Telephone Number	:	610-565-3435
Fax Number	:	610-566-1387

Provider Business Practice Location Address
First Line	:	1088 W BALTIMORE PIKE
Second Line	:	STE 2101
City	:	MEDIA
State	:	PA
Zip	:	19063-5136
Country	:	US
Telephone Number	:	610-565-3435
Fax Number	:	610-566-1387

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/21/2005
Last Update Date	:	12/14/2010

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Directions to “ KENNETH J BOYD M.D.” Practice Location

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