Provider Demographics
NPI:1457307431
Name:BOYLSTON, BEDFORD F (MD)
Entity Type:Individual
Prefix:
First Name:BEDFORD
Middle Name:F
Last Name:BOYLSTON
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 1:7501 SURRATTS RD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-3362
Mailing Address - Country:US
Mailing Address - Phone:301-868-8485
Mailing Address - Fax:301-868-0638
Practice Address - Street 1:7501 SURRATTS RD
Practice Address - Street 2:SUITE 303
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-3362
Practice Address - Country:US
Practice Address - Phone:301-868-8485
Practice Address - Fax:301-868-0638
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00599442086S0129X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KN56Medicare PIN
C76566Medicare UPIN
429555Medicare PIN