Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213EP1101X | Primary Podiatric Medicine | 25MD00320000 | NJ |
N | 213EP1101X | Primary Podiatric Medicine | SC006066 | PA |
Y | 213ES0103X | Foot & Ankle Surgery | 25MD00320000 | NJ |
N | 213ES0103X | Foot & Ankle Surgery | SC006066 | PA |
NPI | 1184885881 |
---|---|
Provider Name | Dr. Amy Mccandless Dougherty |
First Address | Philadelphia, PA 19152-3038 |
Second Address | Philadelphia, PA 19152-3038 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2008 |
Last Update Date | 20/05/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1030852380001 | (05) | PA |
7844107 | (05) | NJ |