Provider Demographics
NPI:1730772922
Name:DOHERTY FAMILY MEDICINE LLC
Entity type:Organization
Organization Name:DOHERTY FAMILY MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:JILL
Authorized Official - Last Name:DOHERTY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:267-564-2021
Mailing Address - Street 1:70 OLD DUBLIN PIKE APT K8
Mailing Address - Street 2:
Mailing Address - City:DOYLESTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18901-3423
Mailing Address - Country:US
Mailing Address - Phone:484-387-0511
Mailing Address - Fax:
Practice Address - Street 1:1703 LANGHORNE NEWTOWN RD STE 3
Practice Address - Street 2:
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-1082
Practice Address - Country:US
Practice Address - Phone:267-564-2021
Practice Address - Fax:267-564-2028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-18
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty