Provider Demographics
NPI:1124080247
Name:BOYARSKY, STEPHANIE ANNE (MD)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ANNE
Last Name:BOYARSKY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1789 N KEYSER AVE
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18508-1250
Mailing Address - Country:US
Mailing Address - Phone:570-969-1904
Mailing Address - Fax:570-207-5314
Practice Address - Street 1:1789 N KEYSER AVE
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18508-1250
Practice Address - Country:US
Practice Address - Phone:570-969-1904
Practice Address - Fax:570-207-5314
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-04
Last Update Date:2010-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD042647L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0461081000OtherPABLUE CROSS
080070777OtherRAILROADMEDICARE
631143OtherFIRST PRIORITY LIFE
001468OtherFIRST PRIORITY HEALTH HMO
001290633OtherUNITED
2Y2168OtherHEALTH AMERICA
27539 E475OtherGGOLD
27539 E475OtherGHP
631143OtherPA BLUE SHIELD
536762OtherAETNA
PA0012220210002Medicaid
0461081000OtherBPC
27539 E475OtherGEISINGER HEALTH/990LD 9H
E59863OtherSTERLING
27539 E475OtherGHP
080070777OtherRAILROADMEDICARE
PAB0631143Medicare ID - Type Unspecified