Provider Demographics
NPI:1447404892
Name:DOHERTY, KATHLEEN MEGHAN (MD)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:MEGHAN
Last Name:DOHERTY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ELLIOT BREAST HEALTH CENTER
Mailing Address - Street 2:185 QUEEN CITY AVE
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03101
Mailing Address - Country:US
Mailing Address - Phone:603-663-2204
Mailing Address - Fax:
Practice Address - Street 1:ELLIOT BREAST HEALTH CENTER
Practice Address - Street 2:185 QUEEN CITY AVE
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03101
Practice Address - Country:US
Practice Address - Phone:603-663-2204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-12
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY60 2497712085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology