Healthcare Provider Details

I. General information

NPI: 1578521068
Provider Name (Legal Business Name): ALAN J DOMBROSKY P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 01/24/2020
Certification Date: 01/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 W 7TH ST
FREDERICK MD
21701-4586
US

IV. Provider business mailing address

PO BOX 37089
BALTIMORE MD
21297-3089
US

V. Phone/Fax

Practice location:
  • Phone: 301-663-9573
  • Fax:
Mailing address:
  • Phone: 240-439-8812
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberC0000842
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberC0000842
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: