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General NPI Number Information
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NPI Number | 1164538609
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Entity Type | Individual
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Provider Name | JOSEPH G DOUGHERTY M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/21/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | WALTER REED ARMY MEDICAL CTR 6900 GEORGIA AVENUE
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City | WASHINGTON
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State | DC
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Zip | 20307-0001
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Country | US
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Telephone | 202-782-5973
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Fax |
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Provider Business Mailing Address
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Address Line | 4809 LISTRA RD
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City | ROCKVILLE
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State | MD
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Zip | 20853-3124
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Country | US
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Telephone | 301-942-4262
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 0101234776
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License Number State | VA
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