Active NPI
Bradford Newton Boyette, PA-C
- Physician Assistant
- Virginia Beach, VA
National Provider Identifier
1316987241
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 0110001544
- Practice address
- 840 First Colonial Rd
Suite 102
Virginia Beach, VA 23451-6106 - Phone
- (757) 422-2212
- Fax
- (757) 422-9177
- NPI assigned
- Jun 8, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 0110001544 | VA | Primary |
Addresses
Primary practice location
840 First Colonial Rd
Suite 102
Virginia Beach, VA 23451-6106
Mailing address
840 First Colonial Rd
Suite 102
Virginia Beach, VA 23451-6106
Phone (757) 422-2212
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0110001544 | VA | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149724800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1219363200000",
"number": "1316987241",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "840 FIRST COLONIAL RD",
"address_2": "SUITE 102",
"city": "VIRGINIA BEACH",
"state": "VA",
"postal_code": "234516106",
"telephone_number": "757-422-2212",
"fax_number": "757-422-9177"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "840 FIRST COLONIAL RD",
"address_2": "SUITE 102",
"city": "VIRGINIA BEACH",
"state": "VA",
"postal_code": "234516106",
"telephone_number": "757-422-2212",
"fax_number": "757-422-9177"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOYETTE",
"first_name": "BRADFORD",
"middle_name": "NEWTON",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-08",
"last_updated": "2008-08-22",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "VA",
"license": "0110001544",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Virginia Beach, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.