Provider Demographics
NPI:1235176645
Name:BOYLES, MELISSA L (MD)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:L
Last Name:BOYLES
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 1:1559 HEATHERWAE LOOP
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43065-9364
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3525 OLENTANGY RIVER RD
Practice Address - Street 2:SUITE 6350
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-3937
Practice Address - Country:US
Practice Address - Phone:614-734-3347
Practice Address - Fax:614-265-2513
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.061606207V00000X
OH35061606B174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHB00729501Medicare ID - Type Unspecified
OHF46921Medicare UPIN