Healthcare Provider Details

I. General information

NPI: 1992486849
Provider Name (Legal Business Name): CAMERON STEWART DOMBLISKY PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2023
Last Update Date: 01/15/2024
Certification Date: 01/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2570 HAYMAKER RD
MONROEVILLE PA
15146-3513
US

IV. Provider business mailing address

230 1ST ST APT 3
ASPINWALL PA
15215-3049
US

V. Phone/Fax

Practice location:
  • Phone: 412-858-2000
  • Fax:
Mailing address:
  • Phone: 814-380-4737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: