Provider Demographics
NPI:1598720815
Name:DOYLE, CAROLYN IV
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:DOYLE
Suffix:IV
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 SENECA ST STE 646C
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14210-1351
Mailing Address - Country:US
Mailing Address - Phone:716-995-4450
Mailing Address - Fax:
Practice Address - Street 1:1208 NIAGARA FALLS BLVD
Practice Address - Street 2:
Practice Address - City:TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14150-8924
Practice Address - Country:US
Practice Address - Phone:716-833-2200
Practice Address - Fax:716-332-0797
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF333830363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP75880Medicare UPIN