1588611818 NPI number — CHARLENE A DOYLE MD

Table of content: CHARLENE A DOYLE MD (NPI 1588611818)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588611818 NPI number — CHARLENE A DOYLE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DOYLE
Provider First Name:
CHARLENE
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1588611818
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/28/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 636019
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45263-6019
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-985-7234
Provider Business Mailing Address Fax Number:
865-985-7077

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
908 W 4TH NORTH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MORRISTOWN
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37814-3894
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-586-4231
Provider Business Practice Location Address Fax Number:
865-985-7077
Provider Enumeration Date:
05/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X , with the licence number:  28180 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3818248 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 64926967 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00282922 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 4108250 . This is a "BS TN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 1588611818 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com