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General NPI Number Information
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NPI Number | 1326399700
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Entity Type | Organization
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Legal Business Name | MARIA D DOHERTY PA
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Dates
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Enumeration Date | 09/26/2012
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Last Update Date | 09/26/2012
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Provider Practice Location Address
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Address Line | 11525 CORTEZ BLVD
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City | BROOKSVILLE
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State | FL
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Zip | 34613-7373
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Country | US
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Telephone | 352-596-9990
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Fax | 352-596-9997
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Provider Business Mailing Address
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Address Line | 11525 CORTEZ BLVD
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City | BROOKSVILLE
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State | FL
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Zip | 34613-7373
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Country | US
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Telephone | 352-596-9990
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Fax | 352-596-9997
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARIA DIGNA DOHERTY
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Credential | PEDIATRICIAN, MD
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Telephone | 352-596-9990
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 170100000X
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Taxonomy Name | Ph.D. Medical Genetics
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License Number | ME0062700
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License Number State | FL
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