Provider Demographics
NPI:1710005087
Name:DOERGER, JOSEPH JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:JAMES
Last Name:DOERGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1918 RANDOLPH RD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28207-1100
Mailing Address - Country:US
Mailing Address - Phone:704-364-8100
Mailing Address - Fax:704-365-2073
Practice Address - Street 1:101 E WT HARRIS BLVD
Practice Address - Street 2:SUITE 5103
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-3485
Practice Address - Country:US
Practice Address - Phone:704-547-9196
Practice Address - Fax:704-547-8775
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2016-08-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH57-010147208600000X
KY43281208600000X
NC2015-00853208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100155740Medicaid
NC1710005087Medicaid
1710005087OtherNPI
OHP00908022OtherRR MEDICARE PTAN
NCNCO658AMedicare PIN
OHP00908022OtherRR MEDICARE PTAN
KY7100155740Medicaid