Provider Demographics
NPI:1609321074
Name:BOYLE, TARA L (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:TARA
Middle Name:L
Last Name:BOYLE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:TARA
Other - Middle Name:L
Other - Last Name:PELLERITO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:11350 MCCORMICK RD
Mailing Address - Street 2:EXECUTIVE PLAZA 1, SUITE 501
Mailing Address - City:HUNT VALLEY
Mailing Address - State:MD
Mailing Address - Zip Code:21031
Mailing Address - Country:US
Mailing Address - Phone:410-329-1071
Mailing Address - Fax:410-329-1054
Practice Address - Street 1:8 SAXON AVE STE A
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-7036
Practice Address - Country:US
Practice Address - Phone:631-206-1034
Practice Address - Fax:631-206-1046
Is Sole Proprietor?:No
Enumeration Date:2016-08-16
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019992-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant