Provider Information for 1477016749
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Mr. MATTHEW COONEY DOUGHERTY
Sex: Male
NPI: 1477016749
Last Updated: 2019-04-12
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1477016749 | ||||||||
| Enumeration Date | 2019-04-12 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 1099 JAY ST STE 200 ROCHESTER, NY 14611-1153 United States Phone: 585-328-0834 | Fax: | ||||||||
| Primary Practice Address | 1099 JAY ST STE 200 ROCHESTER, NY 14611-1153 United States Phone: 585-328-0834 | Fax: | ||||||||
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