Individual
TERRENCE A DOHERTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
19 HALLS RD, OLD LYME, CT 06371-1457
(860) 434-8300
(860) 865-2388
Mailing address
447 MONTAUK AVENUE, NEW LONDON, CT 06320
(860) 447-1426
(860) 447-0348
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
029476
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1294769
—
CT
Enumeration date
09/08/2006
Last updated
12/08/2017
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