Provider Demographics
NPI:1588021257
Name:DOSHI, MACKENZIE (PA-C)
Entity Type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:
Last Name:DOSHI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11055 LITTLE PATUXENT PKWY
Mailing Address - Street 2:STE 203
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-2898
Mailing Address - Country:US
Mailing Address - Phone:410-956-7777
Mailing Address - Fax:
Practice Address - Street 1:3168 BRAVERTON ST
Practice Address - Street 2:SUITE 340
Practice Address - City:EDGEWATER
Practice Address - State:MD
Practice Address - Zip Code:21037-2674
Practice Address - Country:US
Practice Address - Phone:410-956-7777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-26
Last Update Date:2017-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC05963363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant