Provider Demographics
NPI:1417043159
Name:DOROUGH, KAREN LEIGH (MD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:LEIGH
Last Name:DOROUGH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47201
Mailing Address - Country:US
Mailing Address - Phone:812-375-1550
Mailing Address - Fax:812-375-1581
Practice Address - Street 1:1405 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201
Practice Address - Country:US
Practice Address - Phone:812-375-1550
Practice Address - Fax:812-375-1581
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2009-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN0039854207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100083290AMedicaid
IND18344Medicare UPIN
IN100083290AMedicaid