WYATT DOUGHERTY
NPI 1740170455
Student in an Organized Health Care Education/Training Program in Baltimore, MD

Q: What is Wyatt Dougherty's NPI number?

The NPI number for Wyatt Dougherty is 1740170455. It was assigned to this individual provider in the NPPES registry on July 4, 2025.

Q: What is Wyatt Dougherty's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Q: When was this NPI record last updated?

The NPPES record for Wyatt Dougherty was last updated on August 18, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since July 04, 2025PECOS Enrolled

1800 ORLEANS ST # 110, BALTIMORE, MD 21287(410) 955-5020 Get Directions Write a Review

NPPES record last updated: August 18, 2025. Verified against the NPPES registry weekly; last sync: August 16, 2026.

On this page

About Wyatt Dougherty NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

WYATT DOUGHERTY (NPI 1740170455) is an individual student in an organized health care education/training program in Baltimore, Maryland and active in the NPI registry since July 2025. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1740170455

Entity TypeIndividualMale

Primary Taxonomy390200000X

Provider Legal NameWYATT DOUGHERTY

Location Address1800 ORLEANS ST # 110Baltimore, MD 21287-0010

Mailing Address6201 Greenleigh AveMiddle River, MD 21220-2004 · (410) 955-5020 · Fax (410) 500-4266

Phone(410) 955-5020

Sole ProprietorNo

Enumeration DateJuly 4, 2025

Last NPPES UpdateAugust 18, 2025

NPPES CertifiedAugust 18, 2025

✔ NPI 1740170455 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care

Taxonomy Code390200000X

Definition

An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

1800 ORLEANS ST # 110, Baltimore, MD 21287

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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Wyatt Dougherty is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. KHAOULA BEN HAJ FREJ MD

Student in an Organized Health Care Education/Training Program