Charles Dougherty
Anesthesiology in Reston, VA. Individual provider (NPI-1).
NPI number1194717926
StatusActive
Last updated in NPPESJan 11, 2011
Details
- NPI
- 1194717926
- Entity type
- Individual (NPI-1)
- Name
- Charles Dougherty
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Aug 18, 2005
- Last updated
- Jan 11, 2011
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207L00000X | Anesthesiology | 0101233598 | VA | Yes |
Practice location
1850 Town Center PkwyReston, VA 20190-3219
Phone 703-471-0919
Mailing address
11341 Sunset Hills RdReston, VA 20190-5205
Phone 703-471-0919
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