Active NPI
Mary Patricia Dourgarian, MD
- Pediatrics Physician
- Apple Valley, MN
National Provider Identifier
1659619658
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 40390
- Practice address
- 14655 Galaxie Svenue
Apple Valley, MN 55124-8575 - Phone
- (952) 432-6161
- Fax
- (952) 432-7019
- NPI assigned
- Jan 25, 2013
- 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 |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 40390 | MN | Primary |
Addresses
Primary practice location
14655 Galaxie Svenue
Apple Valley, MN 55124-8575
Mailing address
14655 Galaxie Svenue
Apple Valley, MN 55124-8575
Phone (952) 432-6161
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)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 40390 | MN | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1359072000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1359072000000",
"number": "1659619658",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14655 GALAXIE SVENUE",
"city": "APPLE VALLEY",
"state": "MN",
"postal_code": "551248575",
"telephone_number": "952-432-6161",
"fax_number": "952-432-7019"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14655 GALAXIE SVENUE",
"city": "APPLE VALLEY",
"state": "MN",
"postal_code": "551248575",
"telephone_number": "952-432-6161",
"fax_number": "952-432-7019"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DOURGARIAN",
"first_name": "MARY",
"middle_name": "PATRICIA",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-01-25",
"last_updated": "2013-01-25",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "MN",
"license": "40390",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Apple Valley, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.