Matthew T. Doherty, MD
Individual provider Active NPI Diagnostic Ultrasound Physician · Williamsburg, VA
NPI 1356501068 · NPPES record last updated Dec 5, 2019
Key facts
- NPI
- 1356501068
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Diagnostic Ultrasound Physician 2085U0001X
- License
- 0101246161 (VA)
- Practice address
- 5424 Discovery Park Blvd
Williamsburg, VA 23188 - Phone
- (757) 707-3510
- NPI assigned
- Jun 16, 2008
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 6
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Diagnostic Radiology
- Education
- University of Virginia School of Medicine, 2008
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Tidewater Physicians Multispecialty Group, PC
Practice addresses (Care Compare)
1100 Volvo Pkwy
Chesapeake, VA 23320-3341
1540 Breezeport Way
Suite 100
Suffolk, VA 23435-3752
Phone (757) 538-7275
4125 Ironbound Rd
Suite 200
Williamsburg, VA 23188-2666
Phone (757) 345-2829
4421 Virginia Beach Blvd
VA Beach, VA 23462-3114
860 Omni Blvd
Newport News, VA 23606-4430
Hospital & facility affiliations
- Mary Immaculate Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in VA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20130909000809 | VA | Practitioner - Diagnostic Radiology | 3173767381 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0101246161 | VA | MD | Diagnostic Ultrasound Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Tidewater Physicians Multispecialty Group PC | Current |
Accepting new patients | |
| Tidewater Physicians Multispecialty Group PC | Current |
Accepting new patients | |
| MCV Associated Physicians | Diagnostic Ultrasound | Past |
Accepting new patients |
Locations
860 Omni Blvd
Ste 101
Newport News, VA 23606
Phone (757) 223-9794
860 Omni Blvd
Ste 105
Newport News, VA 23606
Phone (757) 873-0952
729 Thimble Shoals Blvd
Newport News, VA 23606
Phone (757) 874-1077
860 Omni Blvd
Newport News, VA 23606
Phone (757) 369-8138
827 Diligence Dr
Ste 100
Newport News, VA 23606
Interoperability endpoints
- https://fhir4.healow.com/fhir/r4/BGFHDD
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Diagnostic Ultrasound Physician | 2085U0001X | 0101246161 | VA | Yes |
Addresses
Primary practice location
5424 Discovery Park Blvd
Williamsburg, VA 23188
Mailing address
860 Omni Blvd Ste 101
Newport News, VA 23606-4430
Phone (757) 232-8769
Other providers in Williamsburg, VA
- Divine Intensive Inc.
- Divine Intensive Inc.
- Joanna Dixon
- Doctors of Williamsburg, PC
- Doctors' Hospital of Williamsburg
- Brittany Leanna Dolan
- Darianne Dolewski
- Charles J Donlan Jr.
- Donna M Corvette MD PLLC
- Stephanie Dorais
All providers in Williamsburg, VA · Diagnostic Ultrasound Physician in Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 5, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.