Provider Demographics
NPI:1164482287
Name:BOYLE, TERESA (MD)
Entity Type:Individual
Prefix:DR
First Name:TERESA
Middle Name:
Last Name:BOYLE
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 1:9715 BURNET RD
Mailing Address - Street 2:STE 200 BLDG 7
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-5215
Mailing Address - Country:US
Mailing Address - Phone:512-334-2654
Mailing Address - Fax:512-623-5290
Practice Address - Street 1:2600 E. MLK JR. BLVD.
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78702
Practice Address - Country:US
Practice Address - Phone:512-334-2600
Practice Address - Fax:512-623-5290
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2015-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK80232085R0001X
MA514832085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1184608-05OtherCSHCN
TX8B7335OtherBLUE SHIELD
TX1184608-04Medicaid
TX920006607OtherRR/MEDICARE
TX1184608-05OtherCSHCN
TX8B7335OtherBLUE SHIELD
TXA59270Medicare UPIN