MEDICARE: DOMINIC FOOA

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
1	163WC0200X	Critical Care Medicine Registered Nurse	091495-21	NH

General Provider Information

NPI Number	:	1134087075
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOMINIC FOOA

Provider Business Mailing Address
First Line	:	333 BORTHWICK AVE STE 100
Second Line	:
City	:	PORTSMOUTH
State	:	NH
Zip	:	03801-4198
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	333 BORTHWICK AVE STE 100
Second Line	:
City	:	PORTSMOUTH
State	:	NH
Zip	:	03801-4198
Country	:	US
Telephone Number	:	603-436-5110
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/12/2026
Last Update Date	:	01/12/2026

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Directions to “ DOMINIC FOOA ” Practice Location

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