Healthcare Provider Details

I. General information

NPI: 1407029051
Provider Name (Legal Business Name): RONALDO L. DOMINGO MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2008
Last Update Date: 04/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 CHRISTIANA MEDICAL CTR
NEWARK DE
19702-1656
US

IV. Provider business mailing address

620 CHRISTIANA MEDICAL CTR
NEWARK DE
19702-1656
US

V. Phone/Fax

Practice location:
  • Phone: 302-731-5548
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State

VIII. Authorized Official

Name: RONALDO DOMINGO
Title or Position: OWNER
Credential: MD
Phone: 302-731-5548