Healthcare Provider Details

I. General information

NPI: 1083080535
Provider Name (Legal Business Name): LUIS WILLIAM DOMINGUEZ MD, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2015
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2333 ONTARIO RD NW
WASHINGTON DC
20009-2627
US

IV. Provider business mailing address

2150 PENNSYLVANIA AVE NW GW MFA DEPARTMENT OF EMERGENCY MEDICINE
WASHINGTON DC DC
20037
US

V. Phone/Fax

Practice location:
  • Phone: 844-796-2797
  • Fax:
Mailing address:
  • Phone: 202-798-0100
  • Fax: 202-379-3570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD046182
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD0085304
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: