Provider Demographics
NPI:1235573429
Name:DAUGHERTY, DONALD (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:
Last Name:DAUGHERTY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 SUSAN DR
Mailing Address - Street 2:
Mailing Address - City:DALLASTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17313-1708
Mailing Address - Country:US
Mailing Address - Phone:717-246-0545
Mailing Address - Fax:
Practice Address - Street 1:170 SUSAN DR
Practice Address - Street 2:
Practice Address - City:DALLASTOWN
Practice Address - State:PA
Practice Address - Zip Code:17313-1708
Practice Address - Country:US
Practice Address - Phone:717-246-0545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-18
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD031667-E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine