MEDICARE: DOMINIC LUIS PAULA RN

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	R237956	MD

General Provider Information

NPI Number	:	1932998580
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOMINIC LUIS PAULA RN

Provider Business Mailing Address
First Line	:	1830 E MONUMENT ST FL 5
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21287-0020
Country	:	US
Telephone Number	:	410-955-4176
Fax Number	:	410-614-1652

Provider Business Practice Location Address
First Line	:	4940 EASTERN AVE # 5
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21224-2735
Country	:	US
Telephone Number	:	410-955-4176
Fax Number	:

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

Provider Enumeration Date	:	05/01/2025
Last Update Date	:	06/11/2026

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