Provider Demographics
NPI:1891426300
Name:BOYLE, TIMOTHY DREW
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:DREW
Last Name:BOYLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 OLD YORK RD
Mailing Address - Street 2:1 WIDENER
Mailing Address - City:ABINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19001-3720
Mailing Address - Country:US
Mailing Address - Phone:215-481-3255
Mailing Address - Fax:215-481-3781
Practice Address - Street 1:1200 OLD YORK RD
Practice Address - Street 2:1 WIDENER
Practice Address - City:ABINGTON
Practice Address - State:PA
Practice Address - Zip Code:19001-3720
Practice Address - Country:US
Practice Address - Phone:215-481-3255
Practice Address - Fax:215-481-3781
Is Sole Proprietor?:No
Enumeration Date:2022-06-23
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA063900363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant