Organization
COLON & RECTAL SURGERY, LTD.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KENNETH J BOYD M.D. (PRESIDENT)
(610) 565-3435
Entity
Organization
Contact information
Practice address
1088 W BALTIMORE PIKE, SUITE 2101, MEDIA, PA 19063-5136
(610) 565-3435
(610) 566-1387
Mailing address
1088 W BALTIMORE PIKE, SUITE 2101, MEDIA, PA 19063-5136
(610) 565-3435
(610) 566-1387
Taxonomy
Speciality
Code
Description
License number
State
208C00000X
Colon & Rectal Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0009855080003
—
PA
01
—
0091202000
INDEPENDENCE BLUE CROSS
PA
01
—
190824
HIGHMARK BLUE SHIELD
PA
01
—
32129
KEYSTONE MERCY HEALTH PLA
PA
01
—
CF6297
PALMETTO GBA
GA
Enumeration date
07/19/2006
Last updated
12/14/2010
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