Healthcare Provider Details

I. General information

NPI: 1518923259
Provider Name (Legal Business Name): DAVID Y DOMINGUEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2006
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 WASHINGTON ST SUITE 468
NEWTON MA
02462-1650
US

IV. Provider business mailing address

733 W 40TH ST STE LL10
BALTIMORE MD
21211-2112
US

V. Phone/Fax

Practice location:
  • Phone: 617-965-6700
  • Fax: 617-965-5239
Mailing address:
  • Phone: 410-243-8632
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0085045
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: