Healthcare Provider Details

I. General information

NPI: 1538348578
Provider Name (Legal Business Name): PATRICIA DOHERTY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2007
Last Update Date: 10/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8737 COLESVILLE RD SUITE 700
SILVER SPRING MD
20910-7901
US

IV. Provider business mailing address

10123 SENATE DR ADMINISTRATION
LANHAM MD
20706-4367
US

V. Phone/Fax

Practice location:
  • Phone: 301-588-8881
  • Fax:
Mailing address:
  • Phone: 301-459-9118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberG10188
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: