Provider Demographics
NPI:1487620571
Name:BOYLE, KEVIN M (MD)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:M
Last Name:BOYLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:252 CHAPMAN RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702-5438
Mailing Address - Country:US
Mailing Address - Phone:302-366-7665
Mailing Address - Fax:302-366-0734
Practice Address - Street 1:252 CHAPMAN ROAD
Practice Address - Street 2:SUITE 150
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19702-5438
Practice Address - Country:US
Practice Address - Phone:302-623-1929
Practice Address - Fax:302-366-1075
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10003160207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1487620571Medicaid
DE1487620571Medicaid
DE625527C16Medicare PIN