Provider Demographics
NPI:1902566581
Name:DOYEN, KRISTOPHER BLAKE (EMT-P)
Entity Type:Individual
Prefix:
First Name:KRISTOPHER
Middle Name:BLAKE
Last Name:DOYEN
Suffix:
Gender:M
Credentials:EMT-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 DEER PARK CT
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20877-1606
Mailing Address - Country:US
Mailing Address - Phone:954-557-0147
Mailing Address - Fax:
Practice Address - Street 1:801 RUSSELL AVE
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20879-3505
Practice Address - Country:US
Practice Address - Phone:954-557-0147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-23
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1955089146L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, ParamedicGroup - Single Specialty