MEDICARE: JENNIFER M BOYLE 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	207V00000X	Obstetrics & Gynecology Physician	MD11835	RI

General Provider Information

NPI Number	:	1891774394
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER M BOYLE MD

Provider Business Mailing Address
First Line	:	375 ALLENS AVE
Second Line	:
City	:	PROVIDENCE
State	:	RI
Zip	:	02905-5010
Country	:	US
Telephone Number	:	401-444-0400
Fax Number	:	401-444-0468

Provider Business Practice Location Address
First Line	:	202 PRAIRIE AVE
Second Line	:
City	:	PROVIDENCE
State	:	RI
Zip	:	02905-2333
Country	:	US
Telephone Number	:	401-444-0570
Fax Number	:	401-444-0427

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

Provider Enumeration Date	:	01/12/2006
Last Update Date	:	07/08/2007

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