Basic Information
| Provider Information | |||||||||
| NPI: | 1346843695 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DOUGHERTY | ||||||||
| FirstName: | KATHRYN | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 229 E BEECHTREE LN | ||||||||
| Address2: | |||||||||
| City: | WAYNE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190873436 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4848027003 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4190 CITY AVE STE 528 | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191311635 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8664538800 | ||||||||
| FaxNumber: | 8447347689 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/19/2020 | ||||||||
| LastUpdateDate: | 11/18/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/18/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | MA061924 | PA | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363A00000X | CA210001370 | DC | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363A00000X | OA005376 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.