Provider Demographics
NPI:1568457448
Name:BOYKIN, JOSEPH V JR (MD)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:V
Last Name:BOYKIN
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 1:2621 GROVE AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23220-4308
Mailing Address - Country:US
Mailing Address - Phone:804-254-5403
Mailing Address - Fax:804-353-8100
Practice Address - Street 1:2621 GROVE AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23220-4308
Practice Address - Country:US
Practice Address - Phone:804-254-5403
Practice Address - Fax:804-353-8100
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101028782208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6901166Medicaid
VA240000226Medicare ID - Type Unspecified
VA017396C42Medicare PIN
VA6901166Medicaid