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General NPI Number Information
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NPI Number | 1639170210
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Entity Type | Individual
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Provider Name | MINERVA DOMINGO MD
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Gender | Female
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Dates
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Enumeration Date | 08/09/2005
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Last Update Date | 11/10/2020
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Provider Practice Location Address
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Address Line | 20 RESEARCH PL
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City | N CHELMSFORD
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State | MA
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Zip | 01863-2454
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Country | US
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Telephone | 978-788-7307
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Fax | 978-788-7890
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Provider Business Mailing Address
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Address Line | 20 RESEARCH PL STE 320
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City | N CHELMSFORD
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State | MA
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Zip | 01863-2455
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Country | US
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Telephone | 978-256-1858
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Fax | 978-788-7890
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 157601
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License Number State | MA
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