Provider Demographics
NPI:1639390776
Name:DAUGHERTY, TODD DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:DAVID
Last Name:DAUGHERTY
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 1:590 COURT ST
Mailing Address - Street 2:
Mailing Address - City:KEENE
Mailing Address - State:NH
Mailing Address - Zip Code:03431-1719
Mailing Address - Country:US
Mailing Address - Phone:603-354-5454
Mailing Address - Fax:
Practice Address - Street 1:168 MAPLE STREET
Practice Address - Street 2:
Practice Address - City:HENNIKER
Practice Address - State:NH
Practice Address - Zip Code:03242
Practice Address - Country:US
Practice Address - Phone:603-354-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2019-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH13580207RR0500X
OH35.084570207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30207436Medicaid
NH000429301Medicare PIN