Provider Demographics
NPI:1790911550
Name:DOUGHERTY, JOSEPH WARD (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:WARD
Last Name:DOUGHERTY
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 1:17 HANCOCK ST
Mailing Address - Street 2:
Mailing Address - City:BAR HARBOR
Mailing Address - State:ME
Mailing Address - Zip Code:04609-1714
Mailing Address - Country:US
Mailing Address - Phone:207-801-5300
Mailing Address - Fax:
Practice Address - Street 1:17 HANCOCK ST
Practice Address - Street 2:
Practice Address - City:BAR HARBOR
Practice Address - State:ME
Practice Address - Zip Code:04609-1714
Practice Address - Country:US
Practice Address - Phone:207-801-5300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-08
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD21005208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMD21005OtherBOARD OF LICENSURE IN MEDICINE
60776OtherAMERICAN BOARD OF SURGERY
CAA104333OtherMEDICAL BOARD OF CALIFORNIA
60776OtherAMERICAN BOARD OF SURGERY