Provider Demographics
NPI:1073532412
Name:BOYD, MARJORIE ANN (MD)
Entity Type:Individual
Prefix:
First Name:MARJORIE
Middle Name:ANN
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 1:19 BRAMHALL ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-3101
Mailing Address - Country:US
Mailing Address - Phone:207-774-5662
Mailing Address - Fax:207-772-1249
Practice Address - Street 1:19 BRAMHALL ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-3101
Practice Address - Country:US
Practice Address - Phone:207-774-5662
Practice Address - Fax:207-772-1249
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME006795207RH0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME600211OtherMARTINS POINT HEALTH CARE
NH99904253Medicaid
ME014445OtherANTHEM FEDERAL & HMO'S
ME006795OtherTUFTS
MEE000973OtherCHAMPUS/CHAMPVA
MA2019922Medicaid
MEM55780OtherCIGNA
MEE03533Medicare UPIN
NH99904253Medicaid