Provider Demographics
NPI:1629068515
Name:DOUGHERTY, RICHARD ALLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ALLEN
Last Name:DOUGHERTY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:10450 PARK RD
Mailing Address - Street 2:STE 200
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-8505
Mailing Address - Country:US
Mailing Address - Phone:704-541-9002
Mailing Address - Fax:704-542-6701
Practice Address - Street 1:10450 PARK RD
Practice Address - Street 2:STE 200
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-8505
Practice Address - Country:US
Practice Address - Phone:704-541-9002
Practice Address - Fax:704-542-6701
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2022-08-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC9300686207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8929076Medicaid
NC8929076Medicaid
2194464FMedicare PIN