Provider Demographics
NPI:1316906068
Name:BOYLAN, SUSAN ELIZABETH (MD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:ELIZABETH
Last Name:BOYLAN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:9568 KINGS CHARTER DR STE 202
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:VA
Mailing Address - Zip Code:23005-7955
Mailing Address - Country:US
Mailing Address - Phone:804-266-8717
Mailing Address - Fax:804-266-5677
Practice Address - Street 1:2280 OPITZ BLVD
Practice Address - Street 2:SUITE 120
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191
Practice Address - Country:US
Practice Address - Phone:703-670-3349
Practice Address - Fax:703-590-3199
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2018-09-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA01010404132085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC067883200Medicaid
VA7261578Medicaid
VA7261578Medicaid