Provider Demographics
NPI:1255342713
Name:DOYLE, RAYMOND W V (MD)
Entity type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:W
Last Name:DOYLE
Suffix:V
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:RAYMOND
Other - Middle Name:W
Other - Last Name:DOYLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:11121 IVY BUSH LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-1045
Mailing Address - Country:US
Mailing Address - Phone:410-997-0686
Mailing Address - Fax:
Practice Address - Street 1:3020 LIBERTY HEIGHTS AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215
Practice Address - Country:US
Practice Address - Phone:410-664-9436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0013833207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD05339-1200Medicaid
MDC57415Medicare UPIN
MD2904Medicare ID - Type Unspecified