Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 25MA03930700 | NJ |
NPI | 1114060647 |
---|---|
Provider Name | Dr. Joseph F Dougherty |
First Address | Cinnaminson, NJ 08077-4059 |
Second Address | Cinnaminson, NJ 08077-4059 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2007 |
Last Update Date | 08/07/2007 |