Healthcare Provider Details

I. General information

NPI: 1528261328
Provider Name (Legal Business Name): DENNIS DOMBROWSKI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2007
Last Update Date: 04/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 ROLLING RIDGE DR STE 100
STATE COLLEGE PA
16801-7641
US

IV. Provider business mailing address

320 ROLLING RIDGE DR STE 100
STATE COLLEGE PA
16801-7641
US

V. Phone/Fax

Practice location:
  • Phone: 814-867-0670
  • Fax:
Mailing address:
  • Phone: 814-867-0670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number0116019301
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD445184
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: