Provider Demographics
NPI:1255498366
Name:BOYD, JEFFREY R (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:R
Last Name:BOYD
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 1:4102 OGLETOWN STANTON RD
Mailing Address - Street 2:HARMONY PLAZA, SUITE 1
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-4183
Mailing Address - Country:US
Mailing Address - Phone:302-454-8800
Mailing Address - Fax:302-454-8801
Practice Address - Street 1:4102 OGLETOWN STANTON RD
Practice Address - Street 2:HARMONY PLAZA, SUITE 1
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-4183
Practice Address - Country:US
Practice Address - Phone:302-454-8800
Practice Address - Fax:302-454-8801
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD435384207W00000X
DEC1-0008191207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE200108664Medicaid