Healthcare Provider Details

I. General information

NPI: 1326561358
Provider Name (Legal Business Name): MARY DOYLE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2017
Last Update Date: 07/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HURONTARIO ST., #215
MISSISSAUGA ONTARIO
503
CA

IV. Provider business mailing address

1 HURONTARIO ST., #215
MISSISSAUGA ONTARIO
L5G0A3
CA

V. Phone/Fax

Practice location:
  • Phone: 905-274-2229
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberG54449
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: