Provider Demographics
NPI:1699883140
Name:BOYD, JAMES CARROLL (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:CARROLL
Last Name:BOYD
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:41680 MISS BESSIE DR
Mailing Address - Street 2:SUITE 301
Mailing Address - City:LEONARDTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20650-2906
Mailing Address - Country:US
Mailing Address - Phone:301-997-0055
Mailing Address - Fax:301-997-0066
Practice Address - Street 1:41680 MISS BESSIE DR
Practice Address - Street 2:SUITE 301
Practice Address - City:LEONARDTOWN
Practice Address - State:MD
Practice Address - Zip Code:20650-2906
Practice Address - Country:US
Practice Address - Phone:301-997-0055
Practice Address - Fax:301-997-0066
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD19917207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD252661100Medicaid
MD005BMedicare PIN
D76152Medicare UPIN