Provider Demographics
NPI:1053443085
Name:DOHERTY, JAMES MICHAEL (CRT, RCP)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:MICHAEL
Last Name:DOHERTY
Suffix:
Gender:M
Credentials:CRT, RCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 PRESIDENTIAL DR APT A
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:DE
Mailing Address - Zip Code:19807-3218
Mailing Address - Country:US
Mailing Address - Phone:302-658-3147
Mailing Address - Fax:
Practice Address - Street 1:7 PRESIDENTIAL DR APT A
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:DE
Practice Address - Zip Code:19807-3218
Practice Address - Country:US
Practice Address - Phone:302-658-3147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1849247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other