Mary Jo Dougherty, PA - C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

0110003585 Issued in VA

Practice address

700 Oak Grove Rd
Chesapeake, VA 23320-3728

Phone

(757) 977-8500

Fax

(757) 904-1703

NPI assigned

Feb 5, 2007

Sex

Female

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

Enrolled in VA

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/1684/brand/1/csg/1/fhir/r4
• Direct secure messaging: maryjodougherty@pfcov-va.direct.office.nextgen.com
• FHIR API: https://fhir.meditouchehr.com/api/fhir/r4/

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Gershon Pain Specialists, LLC

  • Pain Medicine (Physical Medicine & Rehabilitation) Physician
  • Virginia Beach, VA
  • NPI 1871710798
  Medicare reassignment
• Gershon Pain Specialists, LLC

  • Durable Medical Equipment & Medical Supplies
  • Virginia Beach, VA
  • NPI 1760755847
  NPD
• Ivf Virginia LLC

  • Clinical Medical Laboratory
  • Chesapeake, VA
  • NPI 1316786890
  NPD
• Procreate Fertility Center of Virginia PLLC

  • Reproductive Endocrinology Physician
  • Chesapeake, VA
  • NPI 1134678733
  NPD (past)

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

{
    "created_epoch": "1170633600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723248000000",
    "number": "1578602017",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 OAK GROVE RD",
            "city": "CHESAPEAKE",
            "state": "VA",
            "postal_code": "233203728",
            "telephone_number": "757-977-8500",
            "fax_number": "757-904-1703"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 OAK GROVE RD",
            "city": "CHESAPEAKE",
            "state": "VA",
            "postal_code": "233203728",
            "telephone_number": "757-977-8500",
            "fax_number": "757-904-1703"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOUGHERTY",
        "first_name": "MARY JO",
        "name_prefix": "Mrs.",
        "credential": "PA - C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-05",
        "last_updated": "2024-08-10",
        "certification_date": "2024-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "DE",
            "license": "C5-0000574",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "VA",
            "license": "0110003585",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "PA",
            "license": "MA052848",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carlesha Dorsey, RPH
• Kelly L Dortch, DPT
• Sabrina Dos Santos
• Vickie Lee Doscher, FNP
• Aleah Dotson, COTA/L
• Taylor Raye Doughtie, PSY.D., LCP
• Josiah Douglas
• Michelle Douglas, PT
• Carla Ann Douglass
• Angel Lynn Dove, NP

• Medical Physician Assistant in Chesapeake, VA
• Providers in Chesapeake, VA by specialty
• Medical Physician Assistant in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.