Healthcare Provider Details

I. General information

NPI: 1467377424
Provider Name (Legal Business Name): CHRISTIAN DOMERCHIE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 PENNSYLVANIA AVE SE UNIT 15707
WASHINGTON DC
20003-7529
US

IV. Provider business mailing address

600 PENNSYLVANIA AVE SE UNIT 15707
WASHINGTON DC
20003-7529
US

V. Phone/Fax

Practice location:
  • Phone: 443-690-5857
  • Fax:
Mailing address:
  • Phone: 443-690-5857
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number103K00000X
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: