Provider Demographics
NPI:1063856391
Name:BOYD, ELAINE CHUNG (MD)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:CHUNG
Last Name:BOYD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 TIMBER RUN DR
Mailing Address - Street 2:
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-7623
Mailing Address - Country:US
Mailing Address - Phone:937-422-9318
Mailing Address - Fax:
Practice Address - Street 1:5655 HUDSON DR STE 130
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:OH
Practice Address - Zip Code:44236-4454
Practice Address - Country:US
Practice Address - Phone:330-655-3840
Practice Address - Fax:330-655-3845
Is Sole Proprietor?:No
Enumeration Date:2013-04-17
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.129187207Q00000X
390200000X
GA80494207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0205362Medicaid