Healthcare Provider Details

I. General information

NPI: 1760494892
Provider Name (Legal Business Name): DAVID JOHN DOUGHERTY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 08/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8262 ATLEE RD MOB III, SUITE 205
MECHANICSVILLE VA
23116-1816
US

IV. Provider business mailing address

8262 ATLEE RD MOB III, SUITE 205
MECHANICSVILLE VA
23116-1816
US

V. Phone/Fax

Practice location:
  • Phone: 804-559-0194
  • Fax: 804-559-0198
Mailing address:
  • Phone: 804-559-0194
  • Fax: 804-559-0198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number0101244139
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: