Provider Demographics
NPI:1275571424
Name:BOYLE, MICHELE ROCCO (PA C)
Entity Type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:ROCCO
Last Name:BOYLE
Suffix:
Gender:F
Credentials:PA C
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:
Other - Last Name:ROCCO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:PO BOX 820933
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-0933
Mailing Address - Country:US
Mailing Address - Phone:215-926-3535
Mailing Address - Fax:215-926-3536
Practice Address - Street 1:2301 E ALLEGHENY AVE
Practice Address - Street 2:SUITE 150
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19134-4427
Practice Address - Country:US
Practice Address - Phone:215-926-3535
Practice Address - Fax:215-926-3536
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA002517L363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PACD4829OtherTPI GROUP RAILROAD MEDICARE
PA597586OtherMEDICARE GROUP PTAN TPI
PA085443Medicare ID - Type Unspecified