MEDICARE: DR. ARUNMOZHI DOMINIC 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	207R00000X	Internal Medicine Physician	59000	AZ
2	207R00000X	Internal Medicine Physician	303672	NY

General Provider Information

NPI Number	:	1821633926
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ARUNMOZHI DOMINIC MD

Provider Business Mailing Address
First Line	:	99 E STATE STREET
Second Line	:	PO BOX 1250
City	:	GLOVERSVILLE
State	:	NY
Zip	:	12078-0010
Country	:	US
Telephone Number	:	518-773-5690
Fax Number	:	518-773-5620

Provider Business Practice Location Address
First Line	:	2497 STATE HIGHWAY 30
Second Line	:
City	:	MAYFIELD
State	:	NY
Zip	:	12117-3495
Country	:	US
Telephone Number	:	518-661-5493
Fax Number	:	518-661-7688

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

Provider Enumeration Date	:	11/12/2019
Last Update Date	:	04/17/2024

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