Individual
DR. JOHN U. DOHERTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
925 CHESTNUT ST, MEZZANINE, PHILADELPHIA, PA 19107-4216
(215) 955-5050
(215) 955-7499
Mailing address
925 CHESTNUT ST, MEZZANINE, PHILADELPHIA, PA 19107-4216
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MD021518E
PA
207RC0000X
Cardiovascular Disease Physician
Primary
MD021518E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6695205
—
NJ
05
—
MEDICAID
—
NJ
Enumeration date
07/25/2006
Last updated
07/23/2014
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