Healthcare Provider Details

I. General information

NPI: 1104561026
Provider Name (Legal Business Name): DOMINIQUE GUELCE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2022
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2041 GEORGIA AVE NW
WASHINGTON DC
20060-0001
US

IV. Provider business mailing address

PO BOX 24449
NEW YORK NY
10087-0589
US

V. Phone/Fax

Practice location:
  • Phone: 678-687-2569
  • Fax:
Mailing address:
  • Phone: 833-351-8255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD600005668
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number111844
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number344357
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number4301517241
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: