Brian Dougherty, MB, BCH, BAO

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

036.136528 Issued in IL

Practice address

1562 Mitscher Ave Ste 250
Norfolk, VA 23551-2423

Phone

(757) 443-3872

NPI assigned

Mar 26, 2012

Last updated

Nov 21, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1332720000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732147200000",
    "number": "1194091991",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1562 MITSCHER AVE STE 250",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235512423"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1562 MITSCHER AVE STE 250",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235512423",
            "telephone_number": "757-443-3872"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOUGHERTY",
        "first_name": "BRIAN",
        "credential": "MB, BCH, BAO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-03-26",
        "last_updated": "2024-11-21",
        "certification_date": "2024-11-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "IL",
            "license": "125.062127",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "IL",
            "license": "125062127",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036.136528",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Emily Cushing Dorrance, L.C.S.W.
• Tammie Dorsett
• Kolbi Doss
• Wendy Doster, MD
• Jeanne F. Doucette, L.C.S.W.
• Leslie Zapata Dougherty, LPC
• William M Dougherty, MD
• Douglas John Hughes DDS PC
• Eileen Kate Douglas, PH.D., LPC, ATR-BC
• Marcia Douglas, CMA, CNA, PCA

• Family Medicine Physician in Norfolk, VA
• Providers in Norfolk, VA by specialty
• Family Medicine Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.