Provider Demographics
NPI:1962488809
Name:DOHERTY, JOHN H JR (MD)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:H
Last Name:DOHERTY
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:100 N ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-4903
Mailing Address - Country:US
Mailing Address - Phone:570-271-6144
Mailing Address - Fax:570-271-6578
Practice Address - Street 1:3 W OLIVE ST
Practice Address - Street 2:STE 118
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18508-2572
Practice Address - Country:US
Practice Address - Phone:570-961-3823
Practice Address - Fax:570-207-5988
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2020-06-24
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Provider Licenses
StateLicense IDTaxonomies
PAMD 023457 E207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
C33419Medicare UPIN
PA401859FE4Medicare ID - Type Unspecified