Basic Information
| Provider Information | |||||||||
| NPI: | 1487620571 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BOYLE | ||||||||
| FirstName: | KEVIN | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 252 CHAPMAN RD | ||||||||
| Address2: | SUITE 150 | ||||||||
| City: | NEWARK | ||||||||
| State: | DE | ||||||||
| PostalCode: | 197025438 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3023667665 | ||||||||
| FaxNumber: | 3023660734 | ||||||||
| Practice Location | |||||||||
| Address1: | 252 CHAPMAN ROAD | ||||||||
| Address2: | SUITE 150 | ||||||||
| City: | WILMINGTON | ||||||||
| State: | DE | ||||||||
| PostalCode: | 197025438 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3026231929 | ||||||||
| FaxNumber: | 3023661075 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/27/2006 | ||||||||
| LastUpdateDate: | 11/08/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | C10003160 | DE | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RI0011X | C10003160 | DE | N | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology |
ID Information
| ID | Type | State | Issuer | Description | 1487620571 | 05 | DE | MEDICAID |