Provider Demographics
NPI:1447496328
Name:DONOGHUE, DORIS MARY (MD)
Entity type:Individual
Prefix:DR
First Name:DORIS
Middle Name:MARY
Last Name:DONOGHUE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6233 SOQUEL DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:APTOS
Mailing Address - State:CA
Mailing Address - Zip Code:95003-3184
Mailing Address - Country:US
Mailing Address - Phone:831-464-1425
Mailing Address - Fax:831-708-2101
Practice Address - Street 1:6233 SOQUEL DR
Practice Address - Street 2:SUITE A
Practice Address - City:APTOS
Practice Address - State:CA
Practice Address - Zip Code:95003-3184
Practice Address - Country:US
Practice Address - Phone:831-464-1425
Practice Address - Fax:831-708-2101
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-26
Last Update Date:2008-12-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG0689842084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry