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General NPI Number Information
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NPI Number | 1669443644
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Entity Type | Individual
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Provider Name | JANET MARIE DOUGHERTY MD
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Gender | Female
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Dates
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Enumeration Date | 01/30/2006
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Last Update Date | 07/06/2021
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Provider Practice Location Address
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Address Line | 3501 LOISDALE CT
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City | SPRINGFIELD
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State | VA
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Zip | 22150
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Country | US
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Telephone | 703-359-7878
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Fax |
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Provider Business Mailing Address
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Address Line | 9409 B OLD BURKE LAKE RD
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City | BURKE
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State | VA
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Zip | 22015
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Country | US
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Telephone | 703-978-4200
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Fax | 703-503-8263
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 0101048216
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License Number State | VA
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