Provider Demographics
NPI:1730707159
Name:BOYD, MICHEAL BERNARD
Entity type:Individual
Prefix:
First Name:MICHEAL
Middle Name:BERNARD
Last Name:BOYD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1108 21ST ST NE # E200
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-3150
Mailing Address - Country:US
Mailing Address - Phone:202-294-9946
Mailing Address - Fax:
Practice Address - Street 1:1108 21ST ST NE # E200
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-3150
Practice Address - Country:US
Practice Address - Phone:202-853-3780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-13
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant