Individual
JOHN DOUGHERTY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
333 COTTMAN AVE, H3116, PHILADELPHIA, PA 19111-2434
(215) 728-4074
Mailing address
424 PERKIOMEN AVE, LANSDALE, PA 19446-3529
(215) 368-4756
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
MA051960
PA
Other
Enumeration date
06/11/2007
Last updated
07/08/2007
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