Individual
DR. AMY DOUGHERTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.P.M.
Contact information
Practice address
8001 ROOSEVELT BLVD, SUITE 203, PHILADELPHIA, PA 19152-3038
(215) 332-5300
(215) 332-5228
Mailing address
8001 ROOSEVELT BLVD, SUITE 203, PHILADELPHIA, PA 19152-3038
(215) 332-5300
(215) 332-5228
Taxonomy
Speciality
Code
Description
License number
State
213EP1101X
Primary Podiatric Medicine Podiatrist
25MD00320000
NJ
213EP1101X
Primary Podiatric Medicine Podiatrist
SC006066
PA
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
25MD00320000
NJ
213ES0103X
Foot & Ankle Surgery Podiatrist
SC006066
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1030852380001
—
PA
05
—
7844107
—
NJ
Enumeration date
06/24/2008
Last updated
02/24/2023
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