Healthcare Provider Details

I. General information

NPI: 1841234580
Provider Name (Legal Business Name): DOMINIQUE EL-KHAWAND M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 06/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 MONUMENT RD SUITE 204
YORK PA
17403-5074
US

IV. Provider business mailing address

3421 CONCORD RD
YORK PA
17402-9001
US

V. Phone/Fax

Practice location:
  • Phone: 717-851-2443
  • Fax: 717-851-6129
Mailing address:
  • Phone: 717-851-2443
  • Fax: 717-851-6129

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License NumberMD440249
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: