Provider Demographics
NPI:1477558229
Name:BOYD, JOHN WILLIAM (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:WILLIAM
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 1:856 J CLYDE MORRIS BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23601-1318
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:101 PHILIP ROTH ST
Practice Address - Street 2:SUITE 5A
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-1393
Practice Address - Country:US
Practice Address - Phone:757-599-6333
Practice Address - Fax:757-599-7261
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2013-09-25
Deactivation Date:2006-04-03
Deactivation Code:
Reactivation Date:2006-06-23
Provider Licenses
StateLicense IDTaxonomies
VA0101042473207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1477558229Medicaid
C82911Medicare UPIN
VA014215R07Medicare PIN
VAP00420431Medicare PIN