Provider Demographics
NPI:1700868478
Name:BOYER, RICHARD P (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:P
Last Name:BOYER
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 1:452 OLD STREET RD
Mailing Address - Street 2:
Mailing Address - City:PETERBOROUGH
Mailing Address - State:NH
Mailing Address - Zip Code:03458-1263
Mailing Address - Country:US
Mailing Address - Phone:603-924-7191
Mailing Address - Fax:603-924-3569
Practice Address - Street 1:452 OLD STREET RD
Practice Address - Street 2:
Practice Address - City:PETERBOROUGH
Practice Address - State:NH
Practice Address - Zip Code:03458-1263
Practice Address - Country:US
Practice Address - Phone:603-924-7191
Practice Address - Fax:603-924-3569
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-17
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH12864208600000X
MA33942208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30205437Medicaid
MARE842704Medicare PIN
NH30205437Medicaid
RE8427Medicare ID - Type Unspecified