Healthcare Provider Details

I. General information

NPI: 1427026111
Provider Name (Legal Business Name): JOHN DOMIT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 01/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

532 W PITTSBURGH ST
GREENSBURG PA
15601-2239
US

IV. Provider business mailing address

520 JEFFERSON AVE SUITE 400
JEANNETTE PA
15644-2538
US

V. Phone/Fax

Practice location:
  • Phone: 724-832-4450
  • Fax: 724-830-6669
Mailing address:
  • Phone: 724-527-8060
  • Fax: 724-522-4002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD040684L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: