Dr GLEN N DOUGHERTY JR. MD is a male medical professional, specializing in Cardiovascular Disease (cardiology). He graduated in 2000 from University Of South Carolina School Of Medicine.
PROVIDENCE GROUP PRACTICES II LLC
506 N ST
BAMBERG
SC
290031319
Tel: 8032456290
| Npi | 1720021553 |
| Pac Id | 0042228330 |
| Professional Enrollment Id | I20060712000317 |
| Last Name | DOUGHERTY |
| First Name | GLEN |
| Middle Name | N |
| Suffix | JR. |
| Gender | M |
| Credential | MD |
| Medical School Name | UNIVERSITY OF SOUTH CAROLINA SCHOOL OF MEDICINE |
| Graduation Year | 2000 |
| Primary Specialty | CARDIOVASCULAR DISEASE (CARDIOLOGY) |
| Secondary Specialty 1 | INTERNAL MEDICINE |
| Secondary Specialty 2 | |
| Secondary Specialty 3 | |
| Secondary Specialty 4 | |
| All Secondary Specialties | INTERNAL MEDICINE |
| Organization Legal Name | PROVIDENCE GROUP PRACTICES II LLC |
| Group Practice Pac Id | 2668768276 |
| Number Of Group Practice Members | 29 |
| Line 1 Street Address | 506 N ST |
| Line 2 Street Address | |
| Marker Of Address Line 2 Suppression | |
| City | BAMBERG |
| State | SC |
| Zip Code | 290031319 |
| Phone Number | 8032456290 |
| Hospital Affiliation Ccn 1 | 420026 |
| Hospital Affiliation Lbn 1 | PROVIDENCE HEALTH |
| Hospital Affiliation Ccn 2 | 420068 |
| Hospital Affiliation Lbn 2 | TRMC OF ORANGEBURG & CALHOUN |
| Hospital Affiliation Ccn 3 | |
| Hospital Affiliation Lbn 3 | |
| Hospital Affiliation Ccn 4 | |
| Hospital Affiliation Lbn 4 | |
| Hospital Affiliation Ccn 5 | |
| Hospital Affiliation Lbn 5 | |
| Professional Accepts Medicare Assignment | Y |
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