Provider Demographics
NPI:1417989781
Name:BOYD, CHARLES E JR (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:E
Last Name:BOYD
Suffix:JR
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 1:2461 SANTA MONICA BLVD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-2138
Mailing Address - Country:US
Mailing Address - Phone:866-487-7621
Mailing Address - Fax:
Practice Address - Street 1:325 E WOODS DR
Practice Address - Street 2:
Practice Address - City:LITITZ
Practice Address - State:PA
Practice Address - Zip Code:17543-9253
Practice Address - Country:US
Practice Address - Phone:717-823-6125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2008-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD072807L2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001833251Medicaid
OHB04234402OtherMEDICARE PTAN #
PA001833251Medicaid
OHB04234402OtherMEDICARE PTAN #