MEDICARE: MARY BOYLE

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	208600000X	Surgery Physician	D36893	MD

General Provider Information

NPI Number	:	1942411061
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY BOYLE

Provider Business Mailing Address
First Line	:	5427 WATERCRESS PL
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21045-2454
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5427 WATERCRESS PL
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21045-2454
Country	:	US
Telephone Number	:	410-258-1823
Fax Number	:

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

Provider Enumeration Date	:	05/24/2007
Last Update Date	:	07/08/2007

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Directions to “ MARY BOYLE ” Practice Location

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