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NPI Code Detail

MEDICARE: GREGORY S DOMER M.D.

MEDICARE: GREGORY S DOMER M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12086S0129XVascular Surgery PhysicianMD427177PA
22086S0129XVascular Surgery Physician25MA07250800NJ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1003872474
Entity Type Code : Individual
Provider Name (Legal Business Name) : GREGORY S DOMER M.D.
Provider Business Mailing Address
First Line : 801 OSTRUM ST
Second Line :
City : BETHLEHEM
State : PA
Zip : 18015-1000
Country : US
Telephone Number : 484-503-8281
Fax Number : 833-816-5612
Provider Business Practice Location Address
First Line : 3735 NAZARETH RD STE 206
Second Line :
City : EASTON
State : PA
Zip : 18045-8346
Country : US
Telephone Number : 484-503-8281
Fax Number : 833-866-5612
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/25/2006
Last Update Date : 04/02/2019

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