Provider Demographics
NPI:1043490303
Name:BOYNTON, TARA JADE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:TARA
Middle Name:JADE
Last Name:BOYNTON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:JADE
Other - Last Name:CHATMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:200 E UNIVERSITY PKWY
Mailing Address - Street 2:SUITE 655A
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-2828
Mailing Address - Country:US
Mailing Address - Phone:410-554-2044
Mailing Address - Fax:410-554-2198
Practice Address - Street 1:200 E UNIVERSITY PKWY
Practice Address - Street 2:SUITE 655A
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-2828
Practice Address - Country:US
Practice Address - Phone:410-554-2044
Practice Address - Fax:410-554-2198
Is Sole Proprietor?:No
Enumeration Date:2007-11-05
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC03675363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant