Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207SG0201X | Clinical Genetics (M.D.) | 0101239245 | VA |
Y | 208000000X | Pediatrician | 0101239245 | VA |
NPI | 1134149495 |
---|---|
Provider Name | Emily S Doherty |
First Address | Roanoke, VA 24013-2256 |
Second Address | Roanoke, VA 24018-0720 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2006 |
Last Update Date | 02/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
010298423 | (05) | VA |