Basic Information
| Provider Information | |||||||||
| NPI: | 1700843471 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BOONE | ||||||||
| FirstName: | MYLES | ||||||||
| MiddleName: | DUSTIN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | ONE MEDICAL CENTER DRIVE | ||||||||
| Address2: | ANESTHESIOLOGY | ||||||||
| City: | LEBANON | ||||||||
| State: | NH | ||||||||
| PostalCode: | 037560001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6036506177 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | ONE MEDICAL CENTER DRIVE | ||||||||
| Address2: | ANESTHESIOLOGY | ||||||||
| City: | LEBANON | ||||||||
| State: | NH | ||||||||
| PostalCode: | 037560001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6036506177 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/27/2006 | ||||||||
| LastUpdateDate: | 09/25/2018 | ||||||||
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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 | 207LC0200X | 19115 | NH | N | Allopathic & Osteopathic Physicians | Anesthesiology | Critical Care Medicine | 207L00000X | 19115 | NH | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 3113612 | 05 | NH | MEDICAID | AA65827 | 01 | MA | HARVARD PILGRIM | OTHER | J40336 | 01 | MA | BLUE SHIELD | OTHER | 34154 | 01 | MA | BOSTON MEDICAL CENTER | OTHER | 0007865 | 01 | MA | NEIGHBORHOOD HEALTH | OTHER | 1033420 | 05 | VT | MEDICAID | 494984 | 01 | MA | TUFTS MEDICARE PREFERRED | OTHER | 117118 | 01 | MA | FALLON | OTHER | 2122421 | 05 | MA | MEDICAID | 494984 | 01 | MA | TUFTS | OTHER | AA65827 | 01 | MA | HARVARD FREEDOM | OTHER |