1922083922 NPI number — DR. YULIYA ANATOLIEVNA DOMNINA MD

Table of content: DR. YULIYA ANATOLIEVNA DOMNINA MD (NPI 1922083922)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922083922 NPI number — DR. YULIYA ANATOLIEVNA DOMNINA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DOMNINA
Provider First Name:
YULIYA
Provider Middle Name:
ANATOLIEVNA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1922083922
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 744785
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30374-4785
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
202-476-5000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
111 MICHIGAN AVE NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20010-2916
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-476-5000
Provider Business Practice Location Address Fax Number:
704-446-1582
Provider Enumeration Date:
12/13/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  216822 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X , with the licence number: 2007-01413 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2080P0202X , with the licence number: 2007-01413 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2080P0203X , with the licence number: 2007-01413 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2080P0203X , with the licence number: MD048841 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2008335 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5907041 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 146Y3 . This is a "BCBS-NC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 216822 . This is a "TUFTS HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: N13008 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: J26173 . This is a "BCBS OF MA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".