1023012457 NPI number — IMAD DOMAT MD

Table of content: IMAD DOMAT MD (NPI 1023012457)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023012457 NPI number — IMAD DOMAT MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DOMAT
Provider First Name:
IMAD
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1023012457
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/15/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
125 DAUGHERTY DR STE 301
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONROEVILLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15146-2749
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-856-4666
Provider Business Mailing Address Fax Number:
412-856-6907

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
532 S AIKEN AVE STE 411
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PITTSBURGH
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15232-1521
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-681-3140
Provider Business Practice Location Address Fax Number:
412-681-2561
Provider Enumeration Date:
06/13/2005

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: 207RI0011X , with the licence number:  MD038902L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0000X , with the licence number: MD038902L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0209797000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0014146930007 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".