Active NPI
Mark E Doherty, DMD
- Endodontics
- New Bedford, MA
National Provider Identifier
1194818872
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endodontics
- License
- 20947
- Practice address
- 1155 Purchase St.
New Bedford, MA 02740 - Phone
- (508) 997-1766
- Fax
- (508) 996-4558
- NPI assigned
- Oct 2, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Endodontics | 1223E0200X | 20947 | MA | Primary |
Addresses
Primary practice location
1155 Purchase St.
New Bedford, MA 02740
Mailing address
1155 Purchase St.
New Bedford, MA 02740
Phone (508) 997-1766
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150518001404 | MA | Order and Referring Only - Dentist | 7719207661 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20947 | MA | MD | Endodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159747200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1336089600000",
"number": "1194818872",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1155 PURCHASE ST.",
"city": "NEW BEDFORD",
"state": "MA",
"postal_code": "02740",
"telephone_number": "508-997-1766",
"fax_number": "508-996-4558"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1155 PURCHASE ST.",
"city": "NEW BEDFORD",
"state": "MA",
"postal_code": "02740",
"telephone_number": "508-997-1766",
"fax_number": "508-996-4558"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DOHERTY",
"first_name": "MARK",
"middle_name": "E",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-02",
"last_updated": "2012-05-04",
"status": "A"
},
"taxonomies": [
{
"code": "1223E0200X",
"taxonomy_group": "",
"desc": "Dentist, Endodontics",
"state": "MA",
"license": "20947",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New Bedford, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2012; 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.