Provider Demographics
NPI:1255351946
Name:DOHERTY, JOHN CHRISTOPHER (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:CHRISTOPHER
Last Name:DOHERTY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1803 MOUNT ROSE AVE
Mailing Address - Street 2:SUITE B3
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17403-3026
Mailing Address - Country:US
Mailing Address - Phone:717-851-1405
Mailing Address - Fax:717-812-2052
Practice Address - Street 1:4222 LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17406-8083
Practice Address - Country:US
Practice Address - Phone:717-812-2050
Practice Address - Fax:717-812-2052
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD060221L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01105302OtherCAPITAL BLUE CROSS-WMG
PA001647238Medicaid
PA1142437OtherAMERIHEALTH MERCY-WMG
PA248535OtherMAMSI-WMG
PA55801OtherGEISINGER
PA80811OtherUNISON-WMG
PAP002803OtherGATEWAY-WMG
PA32668OtherJOHNS HOPKINS
PA905218OtherHIGHMARK BLUE SHIELD
PA5371651OtherAETNA
MD546100OtherCAREFIRST MD BCBS
PA001647238Medicaid
PA55801OtherGEISINGER
PA5371651OtherAETNA