Provider Demographics
NPI:1588611818
Name:DOYLE, CHARLENE A (MD)
Entity Type:Individual
Prefix:
First Name:CHARLENE
Middle Name:A
Last Name:DOYLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 636019
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-6019
Mailing Address - Country:US
Mailing Address - Phone:865-985-7234
Mailing Address - Fax:865-985-7077
Practice Address - Street 1:908 W 4TH NORTH ST
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37814-3894
Practice Address - Country:US
Practice Address - Phone:423-586-4231
Practice Address - Fax:865-985-7077
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN28180207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3818248Medicaid
KY64926967Medicaid
TNP00282922OtherRAILROAD MEDICARE
TN4108250OtherBS TN
VA1588611818Medicaid
TN4108250OtherBS TN
TN3818248Medicaid
TN103I930165Medicare PIN