Healthcare Provider Details

I. General information

NPI: 1669466223
Provider Name (Legal Business Name): WILLIAM JOSEPH DOHERTY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2005
Last Update Date: 07/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

92 MONTVALE AVE SUITE 1400
STONEHAM MA
02180-3647
US

IV. Provider business mailing address

92 MONTVALE AVE SUITE 1400
STONEHAM MA
02180-3647
US

V. Phone/Fax

Practice location:
  • Phone: 781-279-7040
  • Fax: 781-279-8430
Mailing address:
  • Phone: 781-279-7040
  • Fax: 781-279-8430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number77843
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: