Healthcare Provider Details

I. General information

NPI: 1023012457
Provider Name (Legal Business Name): IMAD DOMAT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2005
Last Update Date: 03/15/2024
Certification Date: 03/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

532 S AIKEN AVE STE 411
PITTSBURGH PA
15232-1521
US

IV. Provider business mailing address

125 DAUGHERTY DR STE 301
MONROEVILLE PA
15146-2749
US

V. Phone/Fax

Practice location:
  • Phone: 412-681-3140
  • Fax: 412-681-2561
Mailing address:
  • Phone: 412-856-4666
  • Fax: 412-856-6907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberMD038902L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD038902L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: