Healthcare Provider Details

I. General information

NPI: 1295123628
Provider Name (Legal Business Name): PATRICK H DOYLE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2015
Last Update Date: 09/28/2023
Certification Date: 09/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 FRUIT ST WHITE 1
BOSTON MA
02114-2621
US

IV. Provider business mailing address

5 HANCOCK ST APT 3
BOSTON MA
02114-4144
US

V. Phone/Fax

Practice location:
  • Phone: 617-724-4100
  • Fax: 617-726-7415
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA5237
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: