Healthcare Provider Details

I. General information

NPI: 1669865283
Provider Name (Legal Business Name): JOSEPH D DIDOMENICO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2015
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1875 W FRYE RD STE 300
CHANDLER AZ
85224-6184
US

IV. Provider business mailing address

2910 N 3RD AVE # 200
PHOENIX AZ
85013-4434
US

V. Phone/Fax

Practice location:
  • Phone: 480-917-5600
  • Fax: 833-973-5423
Mailing address:
  • Phone: 602-406-3181
  • Fax: 833-973-5424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number75713
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: