Provider Demographics
NPI:1548204399
Name:DOYLE-GAY, JEANNETTE MARY (PA-C)
Entity Type:Individual
Prefix:
First Name:JEANNETTE
Middle Name:MARY
Last Name:DOYLE-GAY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 16149
Mailing Address - Street 2:
Mailing Address - City:RUMFORD
Mailing Address - State:RI
Mailing Address - Zip Code:02916-0697
Mailing Address - Country:US
Mailing Address - Phone:401-453-9625
Mailing Address - Fax:401-435-7069
Practice Address - Street 1:164 SUMMITT AVE, ROOM C70
Practice Address - Street 2:THE MIRIAM HOSPITAL
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906
Practice Address - Country:US
Practice Address - Phone:401-793-3922
Practice Address - Fax:401-435-7069
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA2597363AM0700X
RIPA00065363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9093841Medicaid
RI979093841Medicare ID - Type UnspecifiedRI MEDICARE
RI9093841Medicaid
RI979093841Medicare PIN