Provider Demographics
NPI:1942218300
Name:DOUGE, JACQUELINE ROCHELLE (MD)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:ROCHELLE
Last Name:DOUGE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8930 STANFORD BLVD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-5805
Mailing Address - Country:US
Mailing Address - Phone:410-313-7569
Mailing Address - Fax:
Practice Address - Street 1:8930 STANFORD BLVD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-5805
Practice Address - Country:US
Practice Address - Phone:410-313-7569
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0062894208000000X
NJ25MA06824100208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ040747SKZOtherPIN
NJH23563Medicare UPIN