Provider Demographics
NPI:1306172390
Name:DOUGHERTY, KAREN D
Entity type:Individual
Prefix:MS
First Name:KAREN
Middle Name:D
Last Name:DOUGHERTY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 MOUNTAINVIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:BASKING RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07920-3444
Mailing Address - Country:US
Mailing Address - Phone:908-542-3000
Mailing Address - Fax:
Practice Address - Street 1:136 MOUNTAINVIEW BLVD
Practice Address - Street 2:
Practice Address - City:BASKING RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07920-3444
Practice Address - Country:US
Practice Address - Phone:908-542-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-26
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00180400363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0220337Medicaid
NJ0220337Medicaid