Basic Information
Provider Information
NPI: 1528471562
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BOYLE
FirstName: PAMELA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: CPNP-PC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 9910 FRANKLIN SQUARE DR STE 2110
Address2:  
City: BALTIMORE
State: MD
PostalCode: 212364902
CountryCode: US
TelephoneNumber: 4109335412
FaxNumber: 4103672215
Practice Location
Address1: 4225 ALTAMONT PL STE 201
Address2:  
City: WHITE PLAINS
State: MD
PostalCode: 20695
CountryCode: US
TelephoneNumber: 2406071500
FaxNumber: 4103672215
Other Information
ProviderEnumerationDate: 06/06/2014
LastUpdateDate: 05/21/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LP0200XR174612MDY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics

No ID Information.


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