Provider Demographics
NPI:1659532935
Name:BOYLE, KATHLEEN MARY (DO)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:MARY
Last Name:BOYLE
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:367 S GULPH ROAD
Mailing Address - Street 2:ATTN. IPM CREDENTIALING
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-3121
Mailing Address - Country:US
Mailing Address - Phone:610-382-4943
Mailing Address - Fax:610-878-3965
Practice Address - Street 1:8340 LAKEWOOD RANCH BLVD STE 210
Practice Address - Street 2:
Practice Address - City:LAKEWOOD RANCH
Practice Address - State:FL
Practice Address - Zip Code:34202-5185
Practice Address - Country:US
Practice Address - Phone:941-782-2800
Practice Address - Fax:941-782-2513
Is Sole Proprietor?:No
Enumeration Date:2008-06-19
Last Update Date:2017-10-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLOS12961207Q00000X
PAOS014325207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1922077643OtherMLHC GROUP NPI
PA440771OtherMLHC MEDICARE AA #