Healthcare Provider Details

I. General information

NPI: 1720049836
Provider Name (Legal Business Name): DORON R HAUGHTON PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 08/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5401 OLD COURT RD
RANDALLSTOWN MD
21133-5103
US

IV. Provider business mailing address

9203 APPLEFORD CIR AP# 354
OWINGS MILLS MD
21117-8245
US

V. Phone/Fax

Practice location:
  • Phone: 410-521-2200
  • Fax:
Mailing address:
  • Phone: 410-654-1348
  • Fax: 410-654-1348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC03108
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberC0003108
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: