Provider Demographics
NPI:1144226606
Name:BOYD, KENNETH J (MD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:J
Last Name:BOYD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1088 W BALTIMORE PIKE
Mailing Address - Street 2:STE 2101
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-5136
Mailing Address - Country:US
Mailing Address - Phone:610-565-3435
Mailing Address - Fax:610-566-1387
Practice Address - Street 1:1088 W BALTIMORE PIKE
Practice Address - Street 2:STE 2101
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-5136
Practice Address - Country:US
Practice Address - Phone:610-565-3435
Practice Address - Fax:610-566-1387
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD036083E208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011209700002Medicaid
PA32129BOtherKEYSTONE MERCY HEALTH PLA
PA280000253OtherMEDICARE RAILROAD
PA0031097000OtherINDEPENDENCE BLUE CROSS
PA0011209700002Medicaid
PA189225Medicare Oscar/Certification