Provider Demographics
NPI:1750376182
Name:OBOYLE, JULIANNE JEAN (MD)
Entity type:Individual
Prefix:
First Name:JULIANNE
Middle Name:JEAN
Last Name:OBOYLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 PARK ST
Mailing Address - Street 2:
Mailing Address - City:HONESDALE
Mailing Address - State:PA
Mailing Address - Zip Code:18431-1445
Mailing Address - Country:US
Mailing Address - Phone:570-253-8635
Mailing Address - Fax:
Practice Address - Street 1:600 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:HONESDALE
Practice Address - State:PA
Practice Address - Zip Code:18431-1459
Practice Address - Country:US
Practice Address - Phone:570-253-8635
Practice Address - Fax:570-253-8646
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-12
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD049659L2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001467543Medicaid
PA001467543Medicaid
PAF88870Medicare UPIN