Individual
MRS. MARY JO DOUGHERTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA - C
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
0110003585
VA
363AM0700X
Medical Physician Assistant
C5-0000574
DE
363AM0700X
Medical Physician Assistant
MA052848
PA
Other
Enumeration date
02/05/2007
Last updated
08/10/2024
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