Provider Demographics
NPI:1841352655
Name:DOYLE, MARY BETH (MD)
Entity type:Individual
Prefix:
First Name:MARY BETH
Middle Name:
Last Name:DOYLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 MATTHEW ALLEN CT
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:IL
Mailing Address - Zip Code:62294-4009
Mailing Address - Country:US
Mailing Address - Phone:757-763-9933
Mailing Address - Fax:
Practice Address - Street 1:310 W LOSEY ST
Practice Address - Street 2:
Practice Address - City:SCOTT AFB
Practice Address - State:IL
Practice Address - Zip Code:62225-5250
Practice Address - Country:US
Practice Address - Phone:618-256-7018
Practice Address - Fax:618-256-7594
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0116018403208000000X
VA0101242353208000000X
IL036.126007208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics