Provider Demographics
NPI:1770539447
Name:BOYD, MARY S (MD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:S
Last Name:BOYD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO DRAWER 2418
Mailing Address - Street 2:911 GORMAN AVE STE 302
Mailing Address - City:ELKINS
Mailing Address - State:WV
Mailing Address - Zip Code:26241
Mailing Address - Country:US
Mailing Address - Phone:304-636-2920
Mailing Address - Fax:304-636-2921
Practice Address - Street 1:911 GORMAN AVE
Practice Address - Street 2:STE 302
Practice Address - City:ELKINS
Practice Address - State:WV
Practice Address - Zip Code:26241
Practice Address - Country:US
Practice Address - Phone:304-636-2920
Practice Address - Fax:304-636-2921
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WV12283208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0112404000Medicaid
WV0112404000Medicaid