Healthcare Provider Details

I. General information

NPI: 1922358209
Provider Name (Legal Business Name): MEGAN DOHERTY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2012
Last Update Date: 09/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 ORLEANS ST. NICU
BALTIMORE MD
21287
US

IV. Provider business mailing address

1800 ORLEANS ST.
BALTIMORE MD
21287
US

V. Phone/Fax

Practice location:
  • Phone: 410-955-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License Number709110
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: