Provider Demographics
NPI:1922455823
Name:CARRYL, DORIS
Entity Type:Individual
Prefix:
First Name:DORIS
Middle Name:
Last Name:CARRYL
Suffix:
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 1:1312 CLIFTON ST NW APT 415S
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20009
Mailing Address - Country:UM
Mailing Address - Phone:202-390-6140
Mailing Address - Fax:
Practice Address - Street 1:1312 CLIFTON ST NW APT 415S
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-7044
Practice Address - Country:US
Practice Address - Phone:202-390-6140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-20
Last Update Date:2016-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA11944171W00000X, 172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No171W00000XOther Service ProvidersContractor