Provider Demographics
NPI:1164408415
Name:BOYLAN MEDICAL ASSOCIATES PLLC
Entity Type:Organization
Organization Name:BOYLAN MEDICAL ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:SAM
Authorized Official - Last Name:WEHBIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-781-9650
Mailing Address - Street 1:3900 BROWNING PL
Mailing Address - Street 2:SUITE 101
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-6508
Mailing Address - Country:US
Mailing Address - Phone:919-781-9650
Mailing Address - Fax:919-781-3572
Practice Address - Street 1:3900 BROWNING PL
Practice Address - Street 2:SUITE 101
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-6508
Practice Address - Country:US
Practice Address - Phone:919-781-9650
Practice Address - Fax:919-781-3572
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-19
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1164408415OtherNPI
NC89012Y3Medicaid
NC2321358Medicare PIN