MEDICARE: MATTHEW BOYER MD

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	2084P0800X	Psychiatry Physician	293276	NY
2	2084P0802X	Addiction Psychiatry Physician	MD472717	PA
3	2084P0800X	Psychiatry Physician	MD472717	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	293276	OTHER	NY	MEDICAL LICENSE

General Provider Information

NPI Number	:	1609238815
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW BOYER MD

Provider Business Mailing Address
First Line	:	34700 VALLEY RD
Second Line	:
City	:	OCONOMOWOC
State	:	WI
Zip	:	53066-4500
Country	:	US
Telephone Number	:	262-646-4411
Fax Number	:	262-646-1049

Provider Business Practice Location Address
First Line	:	1 WINDING DR STE 106
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19131-2907
Country	:	US
Telephone Number	:	267-787-6600
Fax Number	:	267-787-6819

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

Provider Enumeration Date	:	03/26/2016
Last Update Date	:	09/22/2021

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