Healthcare Provider Details

I. General information

NPI: 1366806481
Provider Name (Legal Business Name): ADAM C DOMICO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2016
Last Update Date: 02/17/2025
Certification Date: 02/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 2ND ST # C
MARIETTA OH
45750-2123
US

IV. Provider business mailing address

611 2ND ST
MARIETTA OH
45750-2123
US

V. Phone/Fax

Practice location:
  • Phone: 740-373-8756
  • Fax: 740-373-0091
Mailing address:
  • Phone: 740-373-8756
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number35.138153
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number35.138153
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: