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NPI Code Detail

MEDICARE: DR. JACQUELINE ROCHELLE DOUGE MD

MEDICARE: DR. JACQUELINE ROCHELLE DOUGE MD
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
1208000000XPediatrics PhysicianD0062894MD
2208000000XPediatrics Physician25MA06824100NJ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1040747SKZOTHERNJPIN

General Provider Information

NPI Number : 1942218300
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JACQUELINE ROCHELLE DOUGE MD
Provider Business Mailing Address
First Line : 8930 STANFORD BLVD
Second Line :
City : COLUMBIA
State : MD
Zip : 21045-5805
Country : US
Telephone Number : 410-313-7569
Fax Number :
Provider Business Practice Location Address
First Line : 8930 STANFORD BLVD
Second Line :
City : COLUMBIA
State : MD
Zip : 21045-5805
Country : US
Telephone Number : 410-313-7569
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/03/2006
Last Update Date : 07/07/2014

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