Healthcare Provider Details

I. General information

NPI: 1043383045
Provider Name (Legal Business Name): DOUGHTY PODIATRY, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 08/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 EASTERN BLVD OFC 1
BALTIMORE MD
21221-6714
US

IV. Provider business mailing address

404 EASTERN BLVD OFC 1
BALTIMORE MD
21221-6714
US

V. Phone/Fax

Practice location:
  • Phone: 410-687-4800
  • Fax: 410-687-3460
Mailing address:
  • Phone: 410-687-4800
  • Fax: 410-687-3460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number01316
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number00244
License Number StateMD

VIII. Authorized Official

Name: DR. MICHAEL ANTHONY DOUGHTY
Title or Position: PRESIDENT
Credential: D.P.M.
Phone: 410-687-4800