MEDICARE: DAVID DOUGHERTY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RX0202X	Medical Oncology Physician	MD434110	PA

General Provider Information

NPI Number	:	1366655920
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID DOUGHERTY M.D.

Provider Business Mailing Address
First Line	:	3400 SPRUCE STREET
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-4204
Country	:	US
Telephone Number	:	215-615-0063
Fax Number	:	215-349-8144

Provider Business Practice Location Address
First Line	:	3400 SPRUCE STREET
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-4204
Country	:	US
Telephone Number	:	215-615-0063
Fax Number	:	215-349-8144

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/08/2007
Last Update Date	:	02/28/2022

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