Provider Demographics
NPI:1679747729
Name:DOYLE, STEPHANIE LAVERNE (MD)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:LAVERNE
Last Name:DOYLE
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1 FEDERAL ST STE 200
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-1088
Mailing Address - Country:US
Mailing Address - Phone:848-288-6935
Mailing Address - Fax:732-790-0107
Practice Address - Street 1:4011 ROUTE 9 SOUTH
Practice Address - Street 2:SUITE 201
Practice Address - City:RIO GRANDE
Practice Address - State:NJ
Practice Address - Zip Code:08204
Practice Address - Country:US
Practice Address - Phone:609-770-7788
Practice Address - Fax:609-770-7774
Is Sole Proprietor?:No
Enumeration Date:2008-04-19
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA063016207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7318707Medicaid
NJ7318707Medicaid