Individual
MR. DERRICK BOYD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
561 FAIRTHORNE AVE., FAIRMOUNT BEHAVIORAL HEALTH SYSTEM, PHILADELPHIA, PA 19128
(215) 582-3405
Mailing address
561 FAIRTHORNE AVE, FAIRMOUNT BEHAVIORAL HEALTH SYSTEM, PHILADELPHIA, PA 19128
(267) 582-3405
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
MA003235L
PA
363AM0700X
Medical Physician Assistant
MA003235L
PA
363AS0400X
Surgical Physician Assistant
MA003235L
PA
Other
Enumeration date
08/01/2008
Last updated
05/01/2015
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