Provider Demographics
NPI:1295966349
Name:BOYLAN MEDICAL ASSOCIATES, PLLC
Entity type:Organization
Organization Name:BOYLAN MEDICAL ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:S
Authorized Official - Last Name:WEHBIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-781-9650
Mailing Address - Street 1:3948 BROWNING PL
Mailing Address - Street 2:SUITE 103
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-6510
Mailing Address - Country:US
Mailing Address - Phone:919-781-9650
Mailing Address - Fax:
Practice Address - Street 1:3948 BROWNING PL
Practice Address - Street 2:SUITE 103
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-6510
Practice Address - Country:US
Practice Address - Phone:919-781-9650
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BOYLAN MEDICAL ASSOCIATES, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-08-06
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89012Y3Medicaid
1295966349OtherNPI
2321358Medicare PIN