Provider Demographics
NPI:1336169390
Name:BOYLE, JENNY LEE (MD)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:LEE
Last Name:BOYLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1 HOSPITAL DR
Mailing Address - Street 2:SUITE 306
Mailing Address - City:LEWISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17837-9314
Mailing Address - Country:US
Mailing Address - Phone:570-522-4110
Mailing Address - Fax:570-768-3911
Practice Address - Street 1:1 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:PA
Practice Address - Zip Code:17837-9350
Practice Address - Country:US
Practice Address - Phone:570-522-2510
Practice Address - Fax:570-768-3911
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD029423E207ZC0500X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA10933540004Medicaid
PA50010277OtherCAPITAL BLUE CROSS
PA321847OtherHEALTH AMERICA
PA410394OtherBLUE SHIELD
PAP00004773OtherRAILROAD MEDICARE
PA321847OtherHEALTH AMERICA
PA50010277OtherCAPITAL BLUE CROSS