Provider Demographics
NPI:1891970091
Name:DOUGHERTY, LELA EVELYN (MD)
Entity Type:Individual
Prefix:
First Name:LELA
Middle Name:EVELYN
Last Name:DOUGHERTY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LELA
Other - Middle Name:EVELYN
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4284 WILLIAM FLYNN HWY STE 102
Mailing Address - Street 2:
Mailing Address - City:ALLISON PARK
Mailing Address - State:PA
Mailing Address - Zip Code:15101-1440
Mailing Address - Country:US
Mailing Address - Phone:412-685-3373
Mailing Address - Fax:412-423-5661
Practice Address - Street 1:4284 WILLIAM FLYNN HWY STE 102
Practice Address - Street 2:
Practice Address - City:ALLISON PARK
Practice Address - State:PA
Practice Address - Zip Code:15101
Practice Address - Country:US
Practice Address - Phone:412-685-3373
Practice Address - Fax:412-423-5661
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-07
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD438705207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1025147020002Medicaid