Provider Demographics
NPI:1902268469
Name:BOYDSTUN, NATASHA VICTORIA (DO)
Entity Type:Individual
Prefix:MRS
First Name:NATASHA
Middle Name:VICTORIA
Last Name:BOYDSTUN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:MISS
Other - First Name:NATASHA
Other - Middle Name:VICTORIA
Other - Last Name:BLACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:180 BERRY ST
Mailing Address - Street 2:
Mailing Address - City:NORTH ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845-5707
Mailing Address - Country:US
Mailing Address - Phone:858-699-4428
Mailing Address - Fax:
Practice Address - Street 1:25 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:NEWBURYPORT
Practice Address - State:MA
Practice Address - Zip Code:01950-3867
Practice Address - Country:US
Practice Address - Phone:978-463-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-23
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.014119207P00000X
CA20A19124207P00000X
390200000X
MA285984207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program