Provider Demographics
NPI:1881713501
Name:DOYLE, STEPHEN MICHAEL (DC)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:MICHAEL
Last Name:DOYLE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12805 OLD FORT RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20744-2874
Mailing Address - Country:US
Mailing Address - Phone:301-292-1960
Mailing Address - Fax:301-292-1068
Practice Address - Street 1:12805 OLD FORT RD
Practice Address - Street 2:SUITE 202
Practice Address - City:FORT WASHINGTON
Practice Address - State:MD
Practice Address - Zip Code:20744-2874
Practice Address - Country:US
Practice Address - Phone:301-292-1960
Practice Address - Fax:301-292-1068
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS01854111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD64291901OtherCAREFIRST
MDU74560Medicare UPIN
MD64291901OtherCAREFIRST