Provider Demographics
NPI:1700828894
Name:OBOYLE, LOUIS JOHN (DO)
Entity Type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:JOHN
Last Name:OBOYLE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1473
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18704-0473
Mailing Address - Country:US
Mailing Address - Phone:570-208-5534
Mailing Address - Fax:570-208-5548
Practice Address - Street 1:575 N RIVER ST
Practice Address - Street 2:FOURTH FLOOR
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18764-0999
Practice Address - Country:US
Practice Address - Phone:570-552-4450
Practice Address - Fax:570-552-4455
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS007508L207R00000X, 208M00000X
OH34.0147778208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAOB143593OtherHIGHMARK BLUE SHIELD
PA0014672670006Medicaid
NY02094397OtherNY MEDICAL ASSISTANCE
PA41116OtherGEISINGER HEALTH PLAN
PA002999OtherFIRST PRIORITY HEALTH
PA143593S8GMedicare PIN
NY02094397OtherNY MEDICAL ASSISTANCE
PA0014672670006Medicaid