Provider Demographics
NPI:1760494892
Name:DOUGHERTY, DAVID JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:JOHN
Last Name:DOUGHERTY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:8262 ATLEE RD
Mailing Address - Street 2:MOB III, SUITE 205
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23116-1816
Mailing Address - Country:US
Mailing Address - Phone:804-559-0194
Mailing Address - Fax:804-559-0198
Practice Address - Street 1:8262 ATLEE RD
Practice Address - Street 2:MOB III, SUITE 205
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23116-1816
Practice Address - Country:US
Practice Address - Phone:804-559-0194
Practice Address - Fax:804-559-0198
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2009-08-02
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Provider Licenses
StateLicense IDTaxonomies
VA0101244139208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1760494892Medicaid