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General NPI Number Information
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NPI Number | 1306817564
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Entity Type | Individual
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Provider Name | MICHAEL J DOUGHERTY M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/27/2006
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Last Update Date | 04/06/2009
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Provider Practice Location Address
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Address Line | 155 WILSON AVE DEPT OF RADIATION ONCOLOGY
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City | WASHINGTON
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State | PA
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Zip | 15301-3336
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Country | US
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Telephone | 724-223-3788
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Fax | 724-229-2055
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Provider Business Mailing Address
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Address Line | 2 HOT METAL ST QUANTUM ONE, N431
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City | PITTSBURGH
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State | PA
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Zip | 15203-2348
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Country | US
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Telephone | 412-432-5806
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Fax | 712-432-7691
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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 | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | MD042918L
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License Number State | PA
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