Kevin Russell Dougherty in Glastonbury - Cardiovascular Disease
Kevin Russell Dougherty - NPI 1114188711
Kevin Russell Dougherty is a Cardiovascular Disease in Glastonbury, Connecticut. Kevin Russell Dougherty practices all healthcare services and medical treatments related to Cardiovascular Disease. The NPI Number for Kevin Russell Dougherty is 1114188711. The last update date is 2015-05-20.
Kevin Russell Dougherty's current location address is 305 Western Blvd, Glastonbury, Connecticut. You can contact this provider via phone number 8605220604 and fax number 8605221761. The mailing address for Kevin Russell Dougherty is 305 Western Blvd, Glastonbury, Connecticut. To know further, please read the information below!
Provider Profile Detail
| Provider Name | Kevin Russell Dougherty |
|---|---|
| Address | 305 Western Blvd, Glastonbury, Connecticut |
| Phone Number | 8605220604 |
| Fax Number | 8605221761 |
| Sole Proprietor | Y |
| Credentials | M.D. |
NPI Number Detail
| NPI Number | 1114188711 |
|---|---|
| Provider Enumeration Date | 2008-06-17 |
| Last Updated Date | 2015-05-20 |
Provider Mailing Address Detail
| Address | 305 Western Blvd |
|---|---|
| City | Glastonbury |
| State | Connecticut (CT) |
| Post Code | 60334380 |
| Phone Number | 8605220604 |
| Fax Number | 8605221761 |
Provider's Primary Taxonomy Detail
| Speciality | Cardiovascular Disease |
|---|---|
| Taxonomy | 207Rc0000X |
| Licence No | 247283 |
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Definition: An internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythms. |
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Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| C00585 | CT | MEDICARE PTAN |
Post Comment/ Review Below
What is the Kevin Russell Dougherty's 1114188711?
The Kevin Russell Dougherty's NPI (National Provider Identifier) Number is 1114188711. This unique 10-digit identification number is assigned to health care providers by the Centers for Medicare & Medicaid Services (CMS).
Could you provide the complete physical address where Kevin Russell Dougherty is located?
The Kevin Russell Dougherty is situated at the following address: 305 Western Blvd, Glastonbury, CT, 60334380.
What is the Kevin Russell Dougherty's specialty and taxonomy code?
The Kevin Russell Dougherty's specialty is Cardiovascular Disease, and the corresponding taxonomy code is 207Rc0000X.
On what date was the 1114188711 assigned to Kevin Russell Dougherty?
The Kevin Russell Dougherty was issued its 1114188711 on 2008-06-17, which is the date when this unique identifier was assigned to the organization by the Centers for Medicare & Medicaid Services.
When was the information pertaining to Kevin Russell Dougherty most recently updated or revised?
The details related to Kevin Russell Dougherty, including its address, specialty, and other relevant information, were last updated or revised on 2015-05-20.