=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588983993
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANDREA M. DOYLE, M.D., LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/25/2010
-----------------------------------------------------
Last Update Date | 05/25/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1672 S COUNTY TRL SUITE 302
-----------------------------------------------------
City | EAST GREENWICH
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02818-5098
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-330-0279
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 75 ELDREDGE AVE
-----------------------------------------------------
City | EAST GREENWICH
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02818-3339
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-330-0279
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | DR. ANDREA MARY DOYLE
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 401-330-0279
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208200000X
-----------------------------------------------------
Taxonomy Name | Plastic Surgery Physician
-----------------------------------------------------
License Number | MD11431
-----------------------------------------------------
License Number State | RI
-----------------------------------------------------