Provider Demographics
NPI:1780900399
Name:DOUGHERTY, RYAN ANDREW (CP)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:ANDREW
Last Name:DOUGHERTY
Suffix:
Gender:M
Credentials:CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6320 N CENTER DR
Mailing Address - Street 2:BLDG#15, STE #201
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-4009
Mailing Address - Country:US
Mailing Address - Phone:757-892-5300
Mailing Address - Fax:
Practice Address - Street 1:6320 N CENTER DR
Practice Address - Street 2:BLDG#15, STE #201
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-4009
Practice Address - Country:US
Practice Address - Phone:757-892-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-08
Last Update Date:2010-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist