Individual
CHARLES DOUGHERTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1850 TOWN CENTER PKWY, RESTON, VA 20190-3219
(703) 471-0919
Mailing address
11341 SUNSET HILLS RD, RESTON, VA 20190-5205
(703) 471-0919
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
0101233598
VA
Other
Enumeration date
08/18/2005
Last updated
01/11/2011
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