Basic Information
| Provider Information | |||||||||
| NPI: | 1386757516 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DOYLE | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | F | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 36 LAKEVIEW DRIVE | ||||||||
| Address2: | |||||||||
| City: | GREENFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 01301 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 17 BELMONT AVENUE | ||||||||
| Address2: | |||||||||
| City: | BRATTLEBORO | ||||||||
| State: | VT | ||||||||
| PostalCode: | 05301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8022570341 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0102X | 0420006171 | VT | Y | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology | 207ZP0102X | 36424 | MA | N | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
ID Information
| ID | Type | State | Issuer | Description | 224877 | 01 | NH | BCBS | OTHER | 36424 | 01 | MA | TUFTS | OTHER | 8001048 | 01 | VT | LADIES FIRST | OTHER | 30002963 | 05 | NH | MEDICAID | 3001911 | 05 | MA | MEDICAID | 0005913 | 05 | VT | MEDICAID | 19085 | 01 | MA | HEALTH NEW ENGLAND | OTHER |