Healthcare Provider Details

I. General information

NPI: 1669793295
Provider Name (Legal Business Name): MEAGHAN DOMINY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2010
Last Update Date: 06/22/2023
Certification Date: 06/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 CHILDRENS LN DEPARTMENT OF PEDIATRIC CRITICAL CARE
NORFOLK VA
23507-1910
US

IV. Provider business mailing address

601 CHILDRENS LN DEPARTMENT OF PEDIATRIC CRITICAL CARE
NORFOLK VA
23507-1910
US

V. Phone/Fax

Practice location:
  • Phone: 757-668-7331
  • Fax:
Mailing address:
  • Phone: 757-668-7331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number0101260295
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number22668
License Number StateMS
# 3
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number0101260295
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: