Provider Demographics
NPI:1154726362
Name:DOUGHERTY, ROBERT N (PA-C)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:N
Last Name:DOUGHERTY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:520 UPPER CHESAPEAKE DR
Mailing Address - Street 2:SUITE 306
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-4339
Mailing Address - Country:US
Mailing Address - Phone:410-879-2006
Mailing Address - Fax:410-879-0248
Practice Address - Street 1:520 UPPER CHESAPEAKE DR
Practice Address - Street 2:SUITE 306
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-4339
Practice Address - Country:US
Practice Address - Phone:410-879-2006
Practice Address - Fax:410-879-0248
Is Sole Proprietor?:No
Enumeration Date:2014-10-30
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDC0005619363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant