Healthcare Provider Details

I. General information

NPI: 1053507830
Provider Name (Legal Business Name): ANNE M DOUGHERTY AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANNE M ARRAZCAETA AU.D.

II. Dates (important events)

Enumeration Date: 09/14/2007
Last Update Date: 02/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 CHESTNUT ST STE 300
PHILADELPHIA PA
19107-4303
US

IV. Provider business mailing address

1015 CHESTNUT ST STE 300
PHILADELPHIA PA
19107-4303
US

V. Phone/Fax

Practice location:
  • Phone: 215-413-0800
  • Fax: 215-413-0808
Mailing address:
  • Phone: 215-413-0800
  • Fax: 215-413-0808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number41YA00073200
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberO2-0000192
License Number StateDE
# 3
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberB0939
License Number StateNJ
# 4
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAT006091
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: