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General NPI Number Information
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NPI Number | 1184885881
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Entity Type | Individual
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Provider Name | AMY DOUGHERTY D.P.M.
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Gender | Female
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Dates
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Enumeration Date | 06/24/2008
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Last Update Date | 02/24/2023
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Provider Practice Location Address
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Address Line | 8001 ROOSEVELT BLVD SUITE 203
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City | PHILADELPHIA
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State | PA
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Zip | 19152-3038
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Country | US
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Telephone | 215-332-5300
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Fax | 215-332-5228
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Provider Business Mailing Address
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Address Line | 8001 ROOSEVELT BLVD SUITE 203
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City | PHILADELPHIA
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State | PA
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Zip | 19152-3038
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Country | US
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Telephone | 215-332-5300
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Fax | 215-332-5228
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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 | 213EP1101X
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Taxonomy Name | Primary Podiatric Medicine Podiatrist
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License Number | 25MD00320000
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 213EP1101X
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Taxonomy Name | Primary Podiatric Medicine Podiatrist
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License Number | SC006066
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | SC006066
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License Number State | PA
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Taxonomy #4
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 25MD00320000
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License Number State | NJ
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