Basic Information
Provider Information | |||||||||
NPI: | 1700828894 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | OBOYLE | ||||||||
FirstName: | LOUIS | ||||||||
MiddleName: | JOHN | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | D.O. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 1473 | ||||||||
Address2: |   | ||||||||
City: | KINGSTON | ||||||||
State: | PA | ||||||||
PostalCode: | 187040473 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5702085534 | ||||||||
FaxNumber: | 5702085548 | ||||||||
Practice Location | |||||||||
Address1: | 575 N RIVER ST | ||||||||
Address2: | FOURTH FLOOR | ||||||||
City: | WILKES BARRE | ||||||||
State: | PA | ||||||||
PostalCode: | 187640999 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5705524450 | ||||||||
FaxNumber: | 5705524455 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/12/2006 | ||||||||
LastUpdateDate: | 10/16/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 10/16/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | OS007508L | PA | N |   | Allopathic & Osteopathic Physicians | Internal Medicine |   | 208M00000X | 34.0147778 | OH | N |   | Allopathic & Osteopathic Physicians | Hospitalist |   | 208M00000X | OS007508L | PA | Y |   | Allopathic & Osteopathic Physicians | Hospitalist |   |
ID Information
ID | Type | State | Issuer | Description | OB143593 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER | 0014672670006 | 05 | PA |   | MEDICAID | 02094397 | 01 | NY | NY MEDICAL ASSISTANCE | OTHER | 41116 | 01 | PA | GEISINGER HEALTH PLAN | OTHER | 002999 | 01 | PA | FIRST PRIORITY HEALTH | OTHER |