Provider Demographics
NPI:1194879148
Name:BOYD, MARIAN C (RPT)
Entity type:Individual
Prefix:MRS
First Name:MARIAN
Middle Name:C
Last Name:BOYD
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:574 COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01301-9785
Mailing Address - Country:US
Mailing Address - Phone:413-774-7988
Mailing Address - Fax:413-773-7322
Practice Address - Street 1:7 BURNHAM ST
Practice Address - Street 2:
Practice Address - City:TURNERS FALLS
Practice Address - State:MA
Practice Address - Zip Code:01376-1841
Practice Address - Country:US
Practice Address - Phone:413-774-7988
Practice Address - Fax:413-773-7322
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2160174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000038814OtherBMC HEALTHNET
468816OtherTUFTS
MA0370002Medicaid
0042239OtherNEIGHBORHOOD HEALTH PLAN
P00307614OtherRAILROAD MEDICARE
MABOY66267OtherBLUE CROSS/BLUE SHIELD
MA0370002Medicaid