Provider Demographics
NPI:1043383045
Name:DOUGHTY PODIATRY, P.A.
Entity Type:Organization
Organization Name:DOUGHTY PODIATRY, P.A.
Other - Org Name:MICHAEL A. DOUGHTY, D.P.M.
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:DOUGHTY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:410-687-4800
Mailing Address - Street 1:404 EASTERN BLVD OFC 1
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21221-6714
Mailing Address - Country:US
Mailing Address - Phone:410-687-4800
Mailing Address - Fax:410-687-3460
Practice Address - Street 1:404 EASTERN BLVD OFC 1
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21221-6714
Practice Address - Country:US
Practice Address - Phone:410-687-4800
Practice Address - Fax:410-687-3460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2009-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD00244213E00000X
MD01316213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD6146730001Medicare NSC
MDU83748Medicare UPIN
MDT59455Medicare UPIN