Provider Demographics
NPI:1700843471
Name:BOONE, MYLES DUSTIN (MD)
Entity Type:Individual
Prefix:DR
First Name:MYLES
Middle Name:DUSTIN
Last Name:BOONE
Suffix:
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:ONE MEDICAL CENTER DRIVE
Mailing Address - Street 2:ANESTHESIOLOGY
Mailing Address - City:LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03756-0001
Mailing Address - Country:US
Mailing Address - Phone:603-650-6177
Mailing Address - Fax:
Practice Address - Street 1:ONE MEDICAL CENTER DRIVE
Practice Address - Street 2:ANESTHESIOLOGY
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03756-0001
Practice Address - Country:US
Practice Address - Phone:603-650-6177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH19115207LC0200X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3113612Medicaid
MAAA65827OtherHARVARD PILGRIM
MAJ40336OtherBLUE SHIELD
MA34154OtherBOSTON MEDICAL CENTER
MA0007865OtherNEIGHBORHOOD HEALTH
VT1033420Medicaid
MA494984OtherTUFTS MEDICARE PREFERRED
MA117118OtherFALLON
MA2122421Medicaid
MA494984OtherTUFTS
MAAA65827OtherHARVARD FREEDOM
MAHX4926Medicare PIN