Healthcare Provider Details

I. General information

NPI: 1538127485
Provider Name (Legal Business Name): AMY DOOLAN-ROY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1638 OWEN DR
FAYETTEVILLE NC
28304-3424
US

IV. Provider business mailing address

653 N TOWN CENTER DR STE 408
LAS VEGAS NV
89144-0514
US

V. Phone/Fax

Practice location:
  • Phone: 910-609-4592
  • Fax: 910-609-5179
Mailing address:
  • Phone: 702-395-7095
  • Fax: 702-395-3502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: