| NPI | 1053304691 |
|---|---|
| Former Name | TAMMY MARIE DOUGHERTY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA054733) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 010673-1) |
| Enumeration Date | 2005-08-30 |
| Last Update Date | 2020-06-30 |