Mark J Boytim, M.D.
Individual provider Active NPI Specialist · Lewes, DE
NPI 1104857697 · NPPES record last updated Jul 9, 2007
Key facts
- NPI
- 1104857697
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Specialist 174400000X
- License
- C1-0003326 (DE)
- Practice address
- 701 Savannah Rd
Suite B
Lewes, DE 19958-1550 - Phone
- (302) 645-2805
- Fax
- (302) 645-1164
- NPI assigned
- Jul 5, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C1-0003326 | DE | MD | Specialist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | C1-0003326 | DE | Yes |
Addresses
Primary practice location
701 Savannah Rd
Suite B
Lewes, DE 19958-1550
Mailing address
701 Savannah Rd
Suite B
Lewes, DE 19958-1550
Phone (302) 645-2805
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0000089201 | Medicaid | DE |
Other providers in Lewes, DE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 9, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.