Provider Demographics
NPI:1821083650
Name:BOYNTON, MELBOURNE DUNCAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MELBOURNE
Middle Name:DUNCAN
Last Name:BOYNTON
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 1:160 ALLEN ST
Mailing Address - Street 2:
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701-4560
Mailing Address - Country:US
Mailing Address - Phone:802-775-2937
Mailing Address - Fax:802-773-0934
Practice Address - Street 1:160 ALLEN ST
Practice Address - Street 2:
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-4560
Practice Address - Country:US
Practice Address - Phone:802-775-2937
Practice Address - Fax:802-773-0934
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-19
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0420009554174400000X
VT042.0009554207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT4971OtherCAPITAL DISTRICT PHY HEAL
VT959159OtherMOHAWK VALLEY PHYSICIAN
VT00029837OtherBCBS
VT0VN1776Medicaid
VTF69143Medicare UPIN
VT0VN1776Medicaid