Healthcare Provider Details

I. General information

NPI: 1881713501
Provider Name (Legal Business Name): STEPHEN MICHAEL DOYLE D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12805 OLD FORT RD SUITE 202
FORT WASHINGTON MD
20744-2874
US

IV. Provider business mailing address

12805 OLD FORT RD SUITE 202
FORT WASHINGTON MD
20744-2874
US

V. Phone/Fax

Practice location:
  • Phone: 301-292-1960
  • Fax: 301-292-1068
Mailing address:
  • Phone: 301-292-1960
  • Fax: 301-292-1068

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberS01854
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: