Provider Demographics
NPI:1851343131
Name:BOYLAN, MARY J (MD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:J
Last Name:BOYLAN
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Gender:F
Credentials:MD
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Mailing Address - Street 1:920 E 1ST ST
Mailing Address - Street 2:STE 303
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55805-2201
Mailing Address - Country:US
Mailing Address - Phone:218-249-6050
Mailing Address - Fax:218-249-6055
Practice Address - Street 1:920 E 1ST ST
Practice Address - Street 2:STE 303
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55805-2201
Practice Address - Country:US
Practice Address - Phone:218-249-6050
Practice Address - Fax:218-249-6055
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2024-08-07
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Provider Licenses
StateLicense IDTaxonomies
NH33516208G00000X
MN38670208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN201716400Medicaid
MNF25636Medicare UPIN