Provider Demographics
NPI:1265549307
Name:DOHERTY, SEAN T (MD)
Entity type:Individual
Prefix:DR
First Name:SEAN
Middle Name:T
Last Name:DOHERTY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:360 NEWBURY ST
Mailing Address - Street 2:UNIT 402
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-2707
Mailing Address - Country:US
Mailing Address - Phone:978-369-4499
Mailing Address - Fax:866-743-7213
Practice Address - Street 1:1 BROOKLINE PL STE 427
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02445-7296
Practice Address - Country:US
Practice Address - Phone:617-735-8735
Practice Address - Fax:617-735-8735
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2018-03-17
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Provider Licenses
StateLicense IDTaxonomies
MA229269208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0003976Medicaid