Individual
MARK H DOUGHERTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1 ORTHOPEDICS DR, PEABODY, MA 01960-1668
(978) 818-6501
Mailing address
1 ORTHOPEDICS DR, PEABODY, MA 01960-1668
(978) 818-6501
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
79956
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0168114
—
MA
01
—
079956
TUFTS
MA
01
—
AA68155
HARVARD PILGRIM
MA
01
—
J18707
BLUE SHIELD
MA
Enumeration date
05/01/2006
Last updated
03/29/2021
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