Basic Information
| Provider Information | |||||||||
| NPI: | 1194253435 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BOOY | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | NED | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 117 ELLENFIELD ST STE 101 | ||||||||
| Address2: | |||||||||
| City: | PROVIDENCE | ||||||||
| State: | RI | ||||||||
| PostalCode: | 029054541 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4014446779 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1 HOPPIN ST STE 200 | ||||||||
| Address2: | |||||||||
| City: | PROVIDENCE | ||||||||
| State: | RI | ||||||||
| PostalCode: | 029034132 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4014445509 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2017 | ||||||||
| LastUpdateDate: | 06/30/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/30/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 268445 | MA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 271966 | MA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207W00000X | LP04222 | RI | N | Allopathic & Osteopathic Physicians | Ophthalmology | 207W00000X | 88984 | GA | N | Allopathic & Osteopathic Physicians | Ophthalmology | 207W00000X | MD18406 | RI | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
No ID Information.