Provider Demographics
NPI:1871507418
Name:BOYLE, SUSAN H (M D)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:H
Last Name:BOYLE
Suffix:
Gender:F
Credentials:M D
Other - Prefix:
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Mailing Address - Street 1:4245 PLEASANT HILL RD
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-6332
Mailing Address - Country:US
Mailing Address - Phone:770-622-0880
Mailing Address - Fax:770-622-9875
Practice Address - Street 1:300 S CHURCH ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:MD
Practice Address - Zip Code:21769-8043
Practice Address - Country:US
Practice Address - Phone:301-371-9000
Practice Address - Fax:301-371-8905
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2017-04-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA041734207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA041734OtherSTATE LICENSE
MDD0079924OtherSTATE LICENSE
GAF61492Medicare UPIN
GA041734OtherSTATE LICENSE
MD564221YAJTMedicare PIN