Active NPI
Patricia A Doherty, EDD
- Psychiatry Physician
- Brookline, MA
National Provider Identifier
1215905534
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 377
- Practice address
- 1415 Beacon St
Brookline, MA 02446 - Phone
- (617) 738-6200
- Fax
- (617) 739-3510
- NPI assigned
- Mar 11, 2006
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 377 | MA | Primary |
Addresses
Primary practice location
1415 Beacon St
Brookline, MA 02446
Mailing address
1415 Beacon St
Brookline, MA 02446
Phone (617) 738-6200
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| W01080 | Other | BCBS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 377 | MA | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1142035200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1215905534",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1415 BEACON ST",
"city": "BROOKLINE",
"state": "MA",
"postal_code": "02446",
"telephone_number": "617-738-6200",
"fax_number": "617-739-3510"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1415 BEACON ST",
"city": "BROOKLINE",
"state": "MA",
"postal_code": "02446",
"telephone_number": "617-738-6200",
"fax_number": "617-739-3510"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DOHERTY",
"first_name": "PATRICIA",
"middle_name": "A",
"name_prefix": "Dr.",
"credential": "EDD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-03-11",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "MA",
"license": "377",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "W01080",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Brookline, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.