Provider Demographics
NPI:1588205744
Name:BOYLE, BRYAN (PA-C)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:
Last Name:BOYLE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 7TH ST
Mailing Address - Street 2:
Mailing Address - City:VANDLING
Mailing Address - State:PA
Mailing Address - Zip Code:18421-1736
Mailing Address - Country:US
Mailing Address - Phone:570-840-7438
Mailing Address - Fax:
Practice Address - Street 1:5 S WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:JERMYN
Practice Address - State:PA
Practice Address - Zip Code:18433-1121
Practice Address - Country:US
Practice Address - Phone:570-230-0019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-30
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA061058363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical