Provider Demographics
NPI:1881705085
Name:DOUGHTIE, MARK JAMES (ATC)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:JAMES
Last Name:DOUGHTIE
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
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Mailing Address - Street 1:50 MAPLEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:STOUGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02072
Mailing Address - Country:US
Mailing Address - Phone:781-344-1724
Mailing Address - Fax:
Practice Address - Street 1:161 COLLEGE AVE
Practice Address - Street 2:TUFTS UNIVERSITY - SOUSENS GYM
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155
Practice Address - Country:US
Practice Address - Phone:617-627-5145
Practice Address - Fax:617-627-2185
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA102255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer