Provider Demographics
NPI:1003818725
Name:BOYD, TIMOTHY STEPHEN (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:STEPHEN
Last Name:BOYD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 SEYMOUR ST
Mailing Address - Street 2:PO BOX 5037
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06102-8000
Mailing Address - Country:US
Mailing Address - Phone:860-545-2803
Mailing Address - Fax:860-545-1500
Practice Address - Street 1:80 SEYMOUR ST
Practice Address - Street 2:HARTFORD HOSPITAL THE GRAY CANCER CENTER
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06102-8000
Practice Address - Country:US
Practice Address - Phone:860-545-2803
Practice Address - Fax:860-545-1500
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2009-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0377102085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001377101Medicaid
CT920000030Medicare ID - Type Unspecified
CT001377101Medicaid