MEDICARE: DOMINIC W MCKINLEY MD

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	207QS0010X	Sports Medicine (Family Medicine) Physician	9801388	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	9801388	OTHER	NC	NC MEDICAL LICENSE

General Provider Information

NPI Number	:	1518905041
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOMINIC W MCKINLEY MD

Provider Business Mailing Address
First Line	:	PO BOX 5105
Second Line	:
City	:	BELFAST
State	:	ME
Zip	:	04915-5100
Country	:	US
Telephone Number	:	919-220-5255
Fax Number	:

Provider Business Practice Location Address
First Line	:	1915 LENDEW ST
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27408-7033
Country	:	US
Telephone Number	:	336-275-3325
Fax Number	:	336-275-5346

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

Provider Enumeration Date	:	06/04/2006
Last Update Date	:	08/28/2025

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