Provider Demographics
NPI:1861451403
Name:DOYLE, TIMOTHY P (MD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:P
Last Name:DOYLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:7590 AUBURN ROAD, SUITE 014
Mailing Address - Street 2:ATTN: MED STAF
Mailing Address - City:CONCORD TWP
Mailing Address - State:OH
Mailing Address - Zip Code:44077-9176
Mailing Address - Country:US
Mailing Address - Phone:440-354-1899
Mailing Address - Fax:440-354-1845
Practice Address - Street 1:36100 EUCLID AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:WILLOUGHBY
Practice Address - State:OH
Practice Address - Zip Code:44094-4456
Practice Address - Country:US
Practice Address - Phone:440-951-8360
Practice Address - Fax:440-951-9408
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-045614207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000130211OtherANTHEM
OH18958OtherQUALCHOICE
OH341313510TDOtherSUMMACARE
OH060027313OtherRAILROAD MED B
OH2597481OtherUNITED HEALTHCARE
OH0589911Medicaid
OH264168OtherFEDERAL BLACK LUNG
OH4007184OtherAETNA
DO0570093Medicare PIN
OH341313510TDOtherSUMMACARE