Basic Information
Provider Information
NPI: 1164659702
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BOYCE
FirstName: MATTHEW
MiddleName: JEROME
NamePrefix: DR.
NameSuffix:  
Credential: M.D
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2101 E JEFFERSON ST
Address2: KAISER PERMANENTE MEDICARE ENROLLMENT
City: ROCKVILLE
State: MD
PostalCode: 208524908
CountryCode: US
TelephoneNumber: 3018162424
FaxNumber:  
Practice Location
Address1: 655 WATKINS MILL RD
Address2:  
City: GAITHERSBURG
State: MD
PostalCode: 208793301
CountryCode: US
TelephoneNumber: 2406324000
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/22/2009
LastUpdateDate: 10/11/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 10/11/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208M00000XD74081MDY Allopathic & Osteopathic PhysiciansHospitalist 
390200000X11015074AINN Student, Health CareStudent in an Organized Health Care Education/Training Program 

No ID Information.


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