Most Relevant Information
Provider Data
| NPI Number: | 1003481060 |
| Provider Name: | BRIAN DOUGHERTY MD |
| Entity Type: | Individual |
| Taxonomy Code: | 390200000X |
| Specialty: | Student in an Organized Health Care Education/Training Program |
| License Number: | LP05327 |
Most Important Dates
| Enumeration Date: | 05/23/2021 |
| Last Updated: | 05/23/2021 |
Provider Practice Location
593 EDDY ST
PROVIDENCE
RI
029034923
Practice Location Phone/Fax
| Phone: | 4014444741 |
| Fax: | 4014444445 |
Provider Mailing Location
593 EDDY ST
PROVIDENCE
RI
029034923
Provider Mailing Phone/Fax
| Phone: | 4014444741 |
| Fax: | 4014444445 |