DR. KEVIN RUSSELL DOUGHERTY (NPI# 1114188711) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1114188711 |
| Entity Type | Individual |
| Full Name | DR. KEVIN RUSSELL DOUGHERTY |
| Credential | M.D. |
| Practice Address |
85 Seymour St Suite 719 Hartford CT 06106-5501 |
| Mailing Address |
305 Western Blvd Suite 100 Glastonbury CT 06033-4380 |
| Practice Telephone | 8605220604 |
| Practice Fax Number | 8605221761 |
| Mailing Telephone | 8605220604 |
| Mailing Fax Number | 8605221761 |
| Enumeration Date | 2008-06-17 |
| Last Update Date | 2015-05-20 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RC0000X |
Internal Medicine Specialization: Cardiovascular Disease |
52940 | CT | Allopathic & Osteopathic Physicians |
| N | 207RC0000X |
Internal Medicine Specialization: Cardiovascular Disease |
247283 | MA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CT | MEDICARE PTAN | C00585 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578717211 | Kevin Michael Dougherty | Social Worker | 303 S Broadway Ste 200-135, Denver, CO 80209-1558 | 2008-11-07 |
| 1730200635 | Kevin Richard Dougherty | Psychologist | 1910 Wabash Ave, Linwood, NJ 08221-1451 | 2007-04-02 |
| 1407997257 | Kevin Dougherty | Chiropractor | 609 Houle Dr, Billings, MT 59102-4862 | 2007-02-12 |
| 1376944389 | Kevin Patrick Dougherty | Physical Therapist | 1991 Fordham Dr, Fayetteville, NC 28304-3773 | 2014-09-09 |
| 1922412279 | Kevin S. Dougherty | Emergency Medicine | 1726 Shawano Ave, Green Bay, WI 54303-3216 | 2014-06-15 |
| 1598988842 | Kevin Paul Dougherty | Dentist | 475 Shunpike Rd, Chatham, NJ 07928-1528 | 2007-04-11 |
| 1922186998 | Kevin E Dougherty | Internal Medicine | 3100 Blue Ridge Rd, Ste. 300, Raleigh, NC 27612-8036 | 2006-11-01 |
| Street Address |
85 SEYMOUR ST SUITE 719 |
| City | HARTFORD |
| State | CT |
| Zip Code | 06106-5501 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770586471 | Daniel Bruce Fram | Internal Medicine | 85 Seymour St, Ste 821, Hartford, CT 06106 | 2005-05-27 |
| 1255841714 | Danielle Montufar Gleason | Psychologist | 85 Seymour St, Hartford, CT 06106-5501 | 2017-10-10 |
| 1164946760 | Christopher John Krupa-schayer | Nurse Practitioner | 85 Seymour St, Hartford, CT 06106-5501 | 2017-07-26 |
| 1902349251 | Courtney Leigh Davis | Nurse Practitioner | 85 Seymour St, Hartford, CT 06106-5501 | 2016-11-18 |
| 1669927703 | Hartford Healthcare Retail Pharmacy | Pharmacy | 85 Seymour St, Suite 117, Hartford, CT 06106-5501 | 2016-08-18 |
| 1013360254 | Praveen Jayapal | Student in an Organized Health Care Education/Training Program | 85 Seymour St, Hartford, CT 06106-5501 | 2016-07-22 |
| 1457702193 | Kevin Rooney | Physician Assistant | 85 Seymour St, Suite 409, Hartford, CT 06106-5501 | 2016-06-23 |
| 1922455211 | Molly Nathanson | Midwife | 85 Seymour St, Suite 1019, Hartford, CT 06106 | 2016-05-17 |
| 1386090124 | Allyson Rossi | Occupational Therapist | 85 Seymour St, Suite 604, Hartford, CT 06106-5501 | 2016-05-11 |
| 1639539554 | Daniel Gleason | Pharmacist | 85 Seymour St, Suite 117, Hartford, CT 06106-5501 | 2016-03-04 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750907325 | Vartika Kesarwani | Student in an Organized Health Care Education/Training Program | Hartford Hospital Adult Primary Care-brown Stone, 79 Retreat Avenue, Hartford, CT 06106 | 2020-06-19 |
| 1720602865 | Meher Kaur Singha | Student in an Organized Health Care Education/Training Program | Hartford Hospital Adult Primary Care- Brown Stone, 79 Retreat Avenue, Hartford, CT 06106 | 2020-06-04 |
| 1497314140 | Eduardo Mantovani Cardoso | Student in an Organized Health Care Education/Training Program | Hartford Hospital Adut Primary Care - Brown Stone, 79 Retreat Avenue, Hartford, CT 06106 | 2019-06-06 |
| 1114582178 | Dimitrios Drekolias | Student in an Organized Health Care Education/Training Program | Hartford Hospital Adult Primary Care - Brown Stone, 79 Retreat Avenue, Hartford, CT 06106 | 2019-05-06 |
| 1316501687 | Rafae Shaikh | Student in an Organized Health Care Education/Training Program | Hartford Hospital Adult Primary Care Brown Stone, 79 Retreat Avenue, Hartford, CT 06106 | 2019-04-23 |
| 1437643715 | Lucas Bensa | Social Worker | 421 Washington St., Apt C1, Hartford, CT 06106 | 2018-06-19 |
| 1548754310 | Collin Dimler | Physician Assistant | 85 Seymour St Ste 1003, Hartford, CT 06106 | 2018-06-15 |
| 1619460581 | Bryan F Stringer | Student in an Organized Health Care Education/Training Program | 79 Retreat Ave., Hh-adult Primary Care - Brown Stone, Hartford, CT 06106 | 2018-06-14 |
| 1083103972 | Margret Sigurdardottir Blondal | Student in an Organized Health Care Education/Training Program | 282 Washington Street, Ste 4h, Hartford, CT 06106 | 2018-05-07 |
| 1265920995 | Rudra Ramanathan | Student in an Organized Health Care Education/Training Program | 79 Retreat Ave Brown Stone, Hartford, CT 06106 | 2018-04-27 |
| Find all providers in zip 06106 | ||||
| Taxonomy Code | 207RC0000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Cardiovascular Disease |
| An internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythms. |
| Notes: Source: American Osteopathic Board of Internal Medicine, 2008 [7/1/2008: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, http://www.abim.org/. American Osteopathic Board of Internal Medicine, https://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922527050 | Lindacare Inc. | Internal Medicine | 20 Church St Ste 1780, Hartford, CT 06103-1246 | 2017-09-09 |
| 1316203482 | James J Purcell | Internal Medicine | 31 Woodland Street, Apt. 4p, Hartford, CT 06105 | 2012-04-03 |
| 1700106812 | Craig Barry Moskowitz | Internal Medicine | 85 Jefferson Street, Hartford Hospital Cardiology Dept, Hartford, CT 06106 | 2010-06-11 |
| 1336467554 | Expert Care Inc | Internal Medicine | 1111 E Sumner St, Suite A, Hartford, WI 53027-1609 | 2010-05-12 |
| 1699821892 | John Granquist | Internal Medicine | Consulting Cardiologists, P.C., 85 Seymour Street Suite 719, Hartford, CT 06106 | 2007-01-28 |
| 1205851052 | Access Healthcare PC | Internal Medicine | 1229 Albany Avenue, Hartford, CT 06112-2132 | 2006-07-13 |
| 1609874627 | Joseph Francis Mitchel | Internal Medicine | 19 Woodland St, Suite 35, Hartford, CT 06105-2372 | 2005-07-13 |
| 1770586471 | Daniel Bruce Fram | Internal Medicine | 85 Seymour St, Ste 821, Hartford, CT 06106 | 2005-05-27 |
| 1255334207 | Richard Soucier | Internal Medicine | 114 Woodland St, Hartford, CT 06105-1208 | 2005-05-23 |
| 1083058671 | Jordan Hammer Kunkes | Internal Medicine | 100 Retreat Ave, Hartford, CT 06106 | 2013-04-25 |
| Find all providers in HARTFORD | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.