Provider Demographics
NPI:1629344478
Name:DOGHOR, OSARUMEN NICOLE (MD)
Entity Type:Individual
Prefix:MRS
First Name:OSARUMEN
Middle Name:NICOLE
Last Name:DOGHOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:330 BROOKLINE AVENUE
Mailing Address - Street 2:RABB 2
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215
Mailing Address - Country:US
Mailing Address - Phone:617-667-6700
Mailing Address - Fax:617-667-5575
Practice Address - Street 1:330 BROOKLINE AVENUE
Practice Address - Street 2:RABB 2
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215
Practice Address - Country:US
Practice Address - Phone:617-667-6700
Practice Address - Fax:617-667-5575
Is Sole Proprietor?:No
Enumeration Date:2012-03-27
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
390200000X
MA2650072084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program