Individual
JAMES E DOUGHERTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
85 SEYMOUR ST, SUITE 719, HARTFORD, CT 06106-5501
(860) 522-0604
(860) 522-1761
Mailing address
305 WESTERN BLVD, SUITE 100, GLASTONBURY, CT 06033-4380
(860) 522-0604
(860) 522-1761
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
017309
CT
207UN0901X
Nuclear Cardiology Physician
017309
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
010017309CT01
ANTHEM BCBS
CT
01
—
060000677
MCPIN CT HEART PHYSICIANS
CT
01
—
060038840
RAILROAD MEDICARE
CT
05
—
1173095
—
CT
01
—
C00585
PTAN
CT
01
—
CA7937
RAILROAD MEDICARE GROUP #
CT
Enumeration date
10/26/2005
Last updated
05/20/2015
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