Provider Demographics
NPI:1689696908
Name:DOHERTY, MARGARET M (PA)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:M
Last Name:DOHERTY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2615 LAKE DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-6693
Mailing Address - Country:US
Mailing Address - Phone:919-787-5995
Mailing Address - Fax:919-783-9406
Practice Address - Street 1:2615 LAKE DR
Practice Address - Street 2:SUITE 300
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-6693
Practice Address - Country:US
Practice Address - Phone:919-787-5995
Practice Address - Fax:919-783-9406
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2016-06-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC103565363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNCF101BMedicare PIN