Provider Demographics
NPI:1043360126
Name:DAUGHERTY, ELIZABETH LEE (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:LEE
Last Name:DAUGHERTY
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
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Mailing Address - Street 1:5712 ROLAND AVE
Mailing Address - Street 2:1C
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21210-1351
Mailing Address - Country:US
Mailing Address - Phone:410-433-7443
Mailing Address - Fax:
Practice Address - Street 1:1830 E MONUMENT ST
Practice Address - Street 2:5TH FLOOR
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21205-2100
Practice Address - Country:US
Practice Address - Phone:410-955-3467
Practice Address - Fax:410-955-0036
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD64127207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD368300100Medicaid
MDP00839229OtherRRMC
MD368300100Medicaid