MEDICARE: DR. MARTIN DOMINGUEZ M.D., PH.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
1	207RC0000X	Cardiovascular Disease Physician	MD474560	PA

General Provider Information

NPI Number	:	1861734188
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARTIN DOMINGUEZ M.D., PH.D.

Provider Business Mailing Address
First Line	:	PO BOX 13579
Second Line	:
City	:	READING
State	:	PA
Zip	:	19612-3579
Country	:	US
Telephone Number	:	484-628-1324
Fax Number	:

Provider Business Practice Location Address
First Line	:	9501 ROOSEVELT BLVD STE 501
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19114-1030
Country	:	US
Telephone Number	:	215-673-5000
Fax Number	:

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

Provider Enumeration Date	:	03/25/2013
Last Update Date	:	04/16/2024

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