Bianca Alexandria Doherty, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

085.006228 Issued in IL

Practice address

2073 N Clybourn Ave
Chicago, IL 60614-4003

Phone

(773) 665-4016

Fax

(773) 360-6200

NPI assigned

Aug 3, 2017

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1501718400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1511136000000",
    "number": "1053836783",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3909 N WESTERN AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606183741",
            "telephone_number": "773-739-9200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2073 N CLYBOURN AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606144003",
            "telephone_number": "773-665-4016",
            "fax_number": "773-360-6200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOHERTY",
        "first_name": "BIANCA",
        "middle_name": "ALEXANDRIA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-08-03",
        "last_updated": "2017-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085.006228",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael Joseph Dohar, MD
• Kathryn Mary Doheny, PSY.D.
• Mary Elizabeth Doheny, PH.D.
• Jean Marie Doherty-Greenberg, D.M.D.
• Alexander Doherty
• Colleen Patricia Doherty, M.D.
• Daniel Leo Doherty Jr., PA
• Julia Ann Doherty, OTR
• Kathleen O'Neal Doherty, PT, DPT
• Kiley Doherty

• Physician Assistant in Chicago, IL
• Providers in Chicago, IL by specialty
• Physician Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.