Basic Information
| Provider Information | |||||||||
| NPI: | 1255351946 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DOHERTY | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | CHRISTOPHER | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1803 MOUNT ROSE AVE | ||||||||
| Address2: | SUITE B3 | ||||||||
| City: | YORK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 174033026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7178511405 | ||||||||
| FaxNumber: | 7178122052 | ||||||||
| Practice Location | |||||||||
| Address1: | 4222 LINCOLN HWY | ||||||||
| Address2: | |||||||||
| City: | YORK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 174068083 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7178122050 | ||||||||
| FaxNumber: | 7178122052 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2006 | ||||||||
| LastUpdateDate: | 06/13/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD060221L | PA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 01105302 | 01 | PA | CAPITAL BLUE CROSS-WMG | OTHER | 001647238 | 05 | PA | MEDICAID | 1142437 | 01 | PA | AMERIHEALTH MERCY-WMG | OTHER | 248535 | 01 | PA | MAMSI-WMG | OTHER | 55801 | 01 | PA | GEISINGER | OTHER | 80811 | 01 | PA | UNISON-WMG | OTHER | P002803 | 01 | PA | GATEWAY-WMG | OTHER | 32668 | 01 | PA | JOHNS HOPKINS | OTHER | 905218 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER | 5371651 | 01 | PA | AETNA | OTHER | 546100 | 01 | MD | CAREFIRST MD BCBS | OTHER |