Healthcare Provider Details

I. General information

NPI: 1609099431
Provider Name (Legal Business Name): KEITH RICHARD DOMINICK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1245 ELM ST
MANCHESTER NH
03101-1308
US

IV. Provider business mailing address

145 HOLLIS ST
MANCHESTER NH
03101-1235
US

V. Phone/Fax

Practice location:
  • Phone: 603-626-9500
  • Fax: 833-448-1486
Mailing address:
  • Phone: 603-626-9500
  • Fax: 833-448-1486

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number14494
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: