Provider Demographics
NPI:1588622070
Name:DOYLE, DAVID J (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:J
Last Name:DOYLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 ALLEN STREET
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01118
Mailing Address - Country:US
Mailing Address - Phone:413-783-9114
Mailing Address - Fax:413-782-0960
Practice Address - Street 1:1515 ALLEN STREET
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01118
Practice Address - Country:US
Practice Address - Phone:413-783-9114
Practice Address - Fax:413-782-0960
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA46148207PE0004X, 261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA046148OtherCONNECTICARE
MA777782OtherTUFTS HEALTH PLAN
MA0169064Medicaid
MAN51788OtherBLUE CROSS & BLUE SHIELD
MA000000025611OtherBMC HEALTHNET
MA110005648AMedicaid
MA000000025611OtherBMC HEALTHNET
MA046148OtherCONNECTICARE