Basic Information
Provider Information
NPI: 1003805144
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BOYLE
FirstName: JOHN
MiddleName: J
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 460 TOTTEN POND RD
Address2: C/O MZI
City: WALTHAM
State: MA
PostalCode: 024511991
CountryCode: US
TelephoneNumber: 7818909933
FaxNumber: 7818909930
Practice Location
Address1: 4 STATE RD
Address2:  
City: DANVERS
State: MA
PostalCode: 019232567
CountryCode: US
TelephoneNumber: 9787743400
FaxNumber: 9787745884
Other Information
ProviderEnumerationDate: 10/20/2005
LastUpdateDate: 08/08/2012
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207X00000X53963MAY Allopathic & Osteopathic PhysiciansOrthopaedic Surgery 

ID Information
IDTypeStateIssuerDescription
1778701MAHPHCOTHER
J0404401MABCBSOTHER
05396301MATUFTSOTHER


Home