Provider Demographics
NPI:1427007541
Name:BOAN, JAROL L (MD)
Entity Type:Individual
Prefix:
First Name:JAROL
Middle Name:L
Last Name:BOAN
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 1:2301 COLUMBIA AVENUE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601
Mailing Address - Country:US
Mailing Address - Phone:717-397-2738
Mailing Address - Fax:717-397-7634
Practice Address - Street 1:2301 COLUMBIA AVENUE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601
Practice Address - Country:US
Practice Address - Phone:717-397-2738
Practice Address - Fax:717-397-7634
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD427830207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1015103700002Medicaid
F77574Medicare UPIN
PA98324Medicare ID - Type Unspecified