Provider Demographics
NPI:1689669764
Name:DOYLE, HEIDI E (PA-C)
Entity Type:Individual
Prefix:MS
First Name:HEIDI
Middle Name:E
Last Name:DOYLE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10412 CHANDLER WAY
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614-6543
Mailing Address - Country:US
Mailing Address - Phone:919-449-2552
Mailing Address - Fax:919-449-2552
Practice Address - Street 1:3320 WAKE FOREST RD
Practice Address - Street 2:SUITE 310
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-7300
Practice Address - Country:US
Practice Address - Phone:919-855-8911
Practice Address - Fax:919-855-9424
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2009-07-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC103348363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2755528AMedicare ID - Type Unspecified
NCP64760Medicare UPIN
NC2755528BMedicare PIN