Provider Demographics
NPI:1649482001
Name:MULLHOLAND, BOYD J (MD)
Entity type:Individual
Prefix:
First Name:BOYD
Middle Name:J
Last Name:MULLHOLAND
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 1:2243 MERMAID PT NE
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33703-3441
Mailing Address - Country:US
Mailing Address - Phone:866-671-5345
Mailing Address - Fax:
Practice Address - Street 1:2243 MERMAID PT NE
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33703-3441
Practice Address - Country:US
Practice Address - Phone:866-671-5345
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME13731208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
D56225Medicare UPIN