Provider Demographics
NPI:1134123615
Name:DWYER, BOYD A (MD)
Entity Type:Individual
Prefix:
First Name:BOYD
Middle Name:A
Last Name:DWYER
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 1:172 THOMAS JOHNSON DR
Mailing Address - Street 2:STE 202
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702
Mailing Address - Country:US
Mailing Address - Phone:301-698-8300
Mailing Address - Fax:301-698-8389
Practice Address - Street 1:172 THOMAS JOHNSON DR
Practice Address - Street 2:STE 202
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702
Practice Address - Country:US
Practice Address - Phone:301-698-8300
Practice Address - Fax:301-698-8389
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2010-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDBD16560362084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC492MMedicare PIN
E83118Medicare UPIN