Healthcare Provider Details

I. General information

NPI: 1861478216
Provider Name (Legal Business Name): GERALD F DOMINICK PA C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2005
Last Update Date: 03/20/2025
Certification Date: 03/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 GAINSBOROUGH SQ STE 400
CHESAPEAKE VA
23320-1714
US

IV. Provider business mailing address

667 KINGSBOROUGH SQ STE 101
CHESAPEAKE VA
23320-4999
US

V. Phone/Fax

Practice location:
  • Phone: 757-842-4499
  • Fax: 757-842-4490
Mailing address:
  • Phone: 757-842-4481
  • Fax: 757-466-8017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA219354
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110000927
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: