Individual
GERALD W DOHERTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
79 KERWIN HILL RD, NORWICH, VT 05055-9475
(802) 649-3225
(802) 371-4488
Mailing address
79 KERWIN HILL RD, NORWICH, VT 05055-9475
(802) 649-3225
(802) 371-4488
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
055-0030712
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9000203
—
VT
Enumeration date
09/20/2005
Last updated
06/03/2008
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