Provider Demographics
NPI:1811164957
Name:DENIS A. BOYLE JR MD
Entity type:Organization
Organization Name:DENIS A. BOYLE JR MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DENIS
Authorized Official - Middle Name:A
Authorized Official - Last Name:BOYLE
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:610-352-7816
Mailing Address - Street 1:111 LONG LN
Mailing Address - Street 2:
Mailing Address - City:UPPER DARBY
Mailing Address - State:PA
Mailing Address - Zip Code:19082-3112
Mailing Address - Country:US
Mailing Address - Phone:610-352-7816
Mailing Address - Fax:610-352-1423
Practice Address - Street 1:111 LONG LN
Practice Address - Street 2:
Practice Address - City:UPPER DARBY
Practice Address - State:PA
Practice Address - Zip Code:19082-3112
Practice Address - Country:US
Practice Address - Phone:610-352-7816
Practice Address - Fax:610-352-1423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-08
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA039066L208D00000X
PA039006L208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PADN5595OtherMEDICARE PTAN
C30829Medicare UPIN