Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | 35.072046 | OH |
NPI | 1386669810 |
---|---|
Provider Name | Dr. Patrick T Boylan |
First Address | Mentor, OH 44060-8723 |
Second Address | Mentor, OH 44060-4597 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2006 |
Last Update Date | 02/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2022846A | (02) | NC |
89135FJ | (05) | NC |
G93091 | (02) | NC |