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General NPI Number Information
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NPI Number | 1043740483
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Entity Type | Individual
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Provider Name | RACHEL ELLEN DOUGHERTY MD
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Gender | Female
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Dates
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Enumeration Date | 06/18/2017
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Last Update Date | 10/20/2022
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Provider Practice Location Address
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Address Line | 2400 17TH ST
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City | COLUMBUS
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State | IN
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Zip | 47201-5351
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Country | US
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Telephone | 812-376-5322
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1329
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City | COLUMBUS
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State | IN
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Zip | 47202-1329
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Country | US
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Telephone | 812-418-0014
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 11019499A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | 01085333A
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License Number State | IN
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