Provider Demographics
NPI:1659619658
Name:DOURGARIAN, MARY PATRICIA (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:PATRICIA
Last Name:DOURGARIAN
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 1:14655 GALAXIE SVENUE
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55124-8575
Mailing Address - Country:US
Mailing Address - Phone:952-432-6161
Mailing Address - Fax:952-432-7019
Practice Address - Street 1:14655 GALAXIE SVENUE
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55124-8575
Practice Address - Country:US
Practice Address - Phone:952-432-6161
Practice Address - Fax:952-432-7019
Is Sole Proprietor?:No
Enumeration Date:2013-01-25
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN40390208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics