MEDICARE: JOY LOUISE BOONE 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	207Q00000X	Family Medicine Physician	MD038528E	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1427335181	OTHER		CBQ
2	1427335140	OTHER		WHITERIVER
3	104152	OTHER	PA	UPMC
4	000067334	OTHER	PA	HIGHMARK
5	0473267	OTHER	PA	AETNA
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	1409575	OTHER	PA	UNITED MINE WORKERS

General Provider Information

NPI Number	:	1205835709
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOY LOUISE BOONE M.D.

Provider Business Mailing Address
First Line	:	200 LOTHROP ST
Second Line	:	SUITE 9055 FORBES TOWER
City	:	PITTSBURGH
State	:	PA
Zip	:	15213-2536
Country	:	US
Telephone Number	:	412-647-3087
Fax Number	:	412-647-4486

Provider Business Practice Location Address
First Line	:	2347 5TH AVE
Second Line	:
City	:	MCKEESPORT
State	:	PA
Zip	:	15132-1126
Country	:	US
Telephone Number	:	412-673-5504
Fax Number	:	412-673-2150

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

Provider Enumeration Date	:	07/18/2005
Last Update Date	:	01/27/2014

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