Provider Demographics
NPI:1982657193
Name:DOHERTY, MARIA DIGNA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:DIGNA
Last Name:DOHERTY
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 1:11525 CORTEZ BLVD
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34613-7373
Mailing Address - Country:US
Mailing Address - Phone:352-596-9990
Mailing Address - Fax:352-596-9997
Practice Address - Street 1:11525 CORTEZ BLVD
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34613-7373
Practice Address - Country:US
Practice Address - Phone:352-596-9990
Practice Address - Fax:352-596-9997
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME627002080A0000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL371279600Medicaid
FLF04281Medicare UPIN