Provider Demographics
NPI:1306817564
Name:DOUGHERTY, MICHAEL J (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:DOUGHERTY
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 1:2 HOT METAL ST
Mailing Address - Street 2:QUANTUM ONE, N431
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15203-2348
Mailing Address - Country:US
Mailing Address - Phone:412-432-5806
Mailing Address - Fax:712-432-7691
Practice Address - Street 1:155 WILSON AVE
Practice Address - Street 2:DEPT OF RADIATION ONCOLOGY
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-3336
Practice Address - Country:US
Practice Address - Phone:724-223-3788
Practice Address - Fax:724-229-2055
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2009-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD042918L2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA11453237OtherCAQH
PA0014377780002Medicaid
PA0014377780055Medicaid
WV3810002147Medicaid
PA0014377780012Medicaid
OH2586769Medicaid
PA199313OtherHIGHMARK BS
PA0014377780001Medicaid
PA0014377780020Medicaid
PA0014377780020Medicaid
PA0014377780002Medicaid
OH2586769Medicaid
PAP00456388Medicare PIN
PA11453237OtherCAQH
PAF40455Medicare UPIN
PA199313SG7Medicare PIN
PA0014377780055Medicaid
WV3810002147Medicaid
PAP00448396Medicare PIN