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General NPI Number Information
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NPI Number | 1467423871
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Entity Type | Individual
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Provider Name | MARK GERARD DOHERTY MD
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Gender | Male
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Dates
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Enumeration Date | 02/01/2006
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Last Update Date | 04/16/2015
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Provider Practice Location Address
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Address Line | 1625 N GEORGE MASON DR SUITE 475
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City | ARLINGTON
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State | VA
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Zip | 22205-3683
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Country | US
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Telephone | 703-717-4000
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Fax | 703-717-4009
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Provider Business Mailing Address
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Address Line | 1625 N GEORGE MASON DR SUITE 475
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City | ARLINGTON
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State | VA
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Zip | 22205-3683
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Country | US
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Telephone | 703-717-4000
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Fax | 703-717-4009
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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 | 207VX0201X
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Taxonomy Name | Gynecologic Oncology Physician
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License Number | 48014
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | 48014
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License Number State | TN
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Taxonomy #3
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | H4087
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 207VX0201X
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Taxonomy Name | Gynecologic Oncology Physician
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License Number | H4087
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License Number State | TX
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Taxonomy #5
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | MD60066893
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License Number State | WA
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Taxonomy #6
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Taxonomy Code | 207VX0201X
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Taxonomy Name | Gynecologic Oncology Physician
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License Number | MD 60066893
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License Number State | WA
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Taxonomy #7
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Taxonomy Code | 207VX0201X
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Taxonomy Name | Gynecologic Oncology Physician
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License Number | 0101257128
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License Number State | VA
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