Provider Demographics
NPI:1962239608
Name:DOYLE, HEATHER (LAC)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:DOYLE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5423 8TH ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-7717
Mailing Address - Country:US
Mailing Address - Phone:336-337-4295
Mailing Address - Fax:
Practice Address - Street 1:4912 BERWYN RD
Practice Address - Street 2:
Practice Address - City:COLLEGE PARK
Practice Address - State:MD
Practice Address - Zip Code:20740-2111
Practice Address - Country:US
Practice Address - Phone:330-606-6376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-17
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU03147171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist