Individual
KENNETH P DOUGHTY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CSA
Contact information
Practice address
9715 MEDICAL CENTER DR, SUITE 528, ROCKVILLE, MD 20850-3320
(301) 424-1960
(301) 424-1961
Mailing address
9715 MEDICAL CENTER DR, SUITE 528, ROCKVILLE, MD 20850-3320
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
3148
VA
Other
Enumeration date
04/10/2012
Last updated
04/10/2012
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