Provider Demographics
NPI:1932102241
Name:DOUGHERTY, ROBERT P (DO)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:P
Last Name:DOUGHERTY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:601 ELMWOOD AVE BOX 679-B
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-0001
Mailing Address - Country:US
Mailing Address - Phone:585-275-1707
Mailing Address - Fax:585-335-8665
Practice Address - Street 1:111 CLARA BARTON ST
Practice Address - Street 2:
Practice Address - City:DANSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14437
Practice Address - Country:US
Practice Address - Phone:585-335-8661
Practice Address - Fax:585-335-8665
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2023-06-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY209212207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02154621Medicaid
NYH38916Medicare UPIN
NYA100001194Medicare PIN