DR. SEAN MICHAEL DOUGHERTY (NPI# 1407089261) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1407089261 |
| Entity Type | Individual |
| Full Name | DR. SEAN MICHAEL DOUGHERTY |
| Credential | D.P.M. |
| Practice Address |
1620 Pennsylvania Ave Ste A Fairfield CA 94533-3509 |
| Practice Telephone | 7074265644 |
| Practice Fax Number | 7074263156 |
| Mailing Telephone | 7074265644 |
| Mailing Fax Number | 7074263156 |
| Enumeration Date | 2009-08-27 |
| Last Update Date | 2020-09-02 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 213E00000X | Podiatrist | E5009 | CA | Podiatric Medicine & Surgery Service Providers |
| N | 213EP1101X |
Podiatrist Specialization: Primary Podiatric Medicine |
E5009 | CA | Podiatric Medicine & Surgery Service Providers |
| N | 213ES0000X |
Podiatrist Specialization: Sports Medicine |
E5009 | CA | Podiatric Medicine & Surgery Service Providers |
| Y | 213ES0103X |
Podiatrist Specialization: Foot & Ankle Surgery |
E5009 | CA | Podiatric Medicine & Surgery Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | MEDICARE RAILROAD | P01083197 | 01 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 4626 Willow Rd, Suite 200, Pleasanton, CA 945888517 | 9254630470 | 9254630473 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164659413 | Sean Patrick Dougherty | Counselor | 3201 Duveneck Dr, Raleigh, NC 27616-8949 | 2009-06-14 |
| 1902841968 | Sean Michael Dougherty | Psychologist | 5060 Cascade Rd. Se, Suite D, Grand Rapids, MI 49546 | 2006-06-16 |
| 1598391112 | Sean Dougherty | Social Worker | 1650 County Services Pkwy Sw, Marietta, GA 30008-4010 | 2020-03-15 |
| 1265995450 | Sean Campbell Dougherty | Student in an Organized Health Care Education/Training Program | 1215 Lee St, Charlottesville, VA 22908-0816 | 2019-04-13 |
| 1790184778 | Sean Dougherty | Counselor | 1800 Mercy Dr, Suite 302, Orlando, FL 32808-5646 | 2014-08-15 |
| Street Address |
1620 PENNSYLVANIA AVE STE A |
| City | FAIRFIELD |
| State | CA |
| Zip Code | 94533-3509 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518573310 | Dr. Sean Dougherty, Dpm, Inc. | Clinic/Center | 1620 Pennsylvania Ave Ste A, Fairfield, CA 94533-3509 | 2020-09-17 |
| 1992123384 | Camilla Willson | Podiatrist | 1620 Pennsylvania Ave Ste A, Fairfield, CA 94533-3509 | 2014-04-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609487347 | Shayondelice Sledge | Case Manager/Care Coordinator | 3001 N. Texas St., #27, Fairfield, CA 94533 | 2020-08-16 |
| 1508401191 | Tiffany Ann Garcia | Social Worker | 1301 Roman Way, Martinez, CA 94533 | 2019-11-07 |
| 1609424175 | Andrew Stephens | Student in an Organized Health Care Education/Training Program | Dgmc, 101 Bodin Cir, Fairfield, CA 94533 | 2019-08-28 |
| 1821645383 | Michelle Marie Hackett | Marriage & Family Therapist | 1745 Enterprise Dr., Bldg. 2, Ste 1a, Fairfield, CA 94533 | 2019-08-20 |
| 1780154369 | Maria Leonila Ramos Corpuz | Behavior Technician | 744 Empire Street Suite 160, Fairfield, CA 94533 | 2018-11-27 |
| 1629575303 | Jeanne Ann Kiernan | Dentist | 690 Airman Dr, Apo, AA 94533 | 2018-04-10 |
| 1629596820 | Max Kardos | Student in an Organized Health Care Education/Training Program | 801 Empire St., Fairfield, CA 94533 | 2017-09-07 |
| 1780119867 | Justin Denhart Dickson | Student in an Organized Health Care Education/Training Program | 101 Bodin Cir Fairfield Ca 94533, David Grant Medical Center, Fpo, AA 94533 | 2017-04-26 |
| 1639613409 | Behrooz Shafiezadeh | Marriage & Family Therapist | Caminar, 601 Madison Street, Suite D, Fairfield, CA 94533 | 2016-12-13 |
| 1427500164 | Tanya Ayers | Counselor | 801 Empire Street, Fairfield, CA 94533 | 2016-10-28 |
| Find all providers in zip 94533 | ||||
| Taxonomy Code | 213ES0103X |
| Grouping | Podiatric Medicine & Surgery Service Providers |
| Classification | Podiatrist |
| Specialization | Foot & Ankle Surgery |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144539081 | Michael Raymond Kiehl | Podiatrist | 1260 Nilles Rd Bldg A1, Fairfield, OH 45014-7221 | 2010-09-27 |
| 1891188736 | Amarjit Singh Chhatwal | Podiatrist | 2321 Black Rock Tpke, Fairfield, CT 06825-3220 | 2015-03-17 |
| 1538570353 | Centers for Foot & Ankle Care LLC | Podiatrist | 1260 Nilles Rd, Bldg A1, Fairfield, OH 45014-7221 | 2014-05-14 |
| 1992123384 | Camilla Willson | Podiatrist | 1620 Pennsylvania Ave Ste A, Fairfield, CA 94533-3509 | 2014-04-02 |
| 1558687079 | Debbie Sith Calica | Podiatrist | 101 Bodin Cir, Fairfield, CA 94535-1809 | 2010-04-08 |
| 1114256955 | Jennifer K Fong | Podiatrist | 1620 Pennsylvania Ave, Suite A, Fairfield, CA 94533-3551 | 2009-12-07 |
| 1568698009 | Kimberly J Curesky | Podiatrist | 1881 Post Rd, Fairfield, CT 06824-5721 | 2009-06-10 |
| 1316197783 | Jossie Saramma Abraham | Podiatrist | 305 Black Rock Tpke, Fairfield, CT 06825-5508 | 2008-09-23 |
| 1982851549 | Kevin Michael Miller | Podiatrist | 2500 Hilborn Rd, Fairfield, CA 94534-1097 | 2008-08-25 |
| 1861672537 | Eugene Sherwood Dpm, Inc. | Podiatrist | 1260 Nilles Rd, Fairfield, OH 45014-7221 | 2007-11-09 |
| Find all providers in FAIRFIELD | ||||
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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.