1639170210 NPI number — DR. MINERVA DOMINGO MD

Table of content: DR. MINERVA DOMINGO MD (NPI 1639170210)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639170210 NPI number — DR. MINERVA DOMINGO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DOMINGO
Provider First Name:
MINERVA
Provider Middle Name:
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:
1639170210
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/10/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20 RESEARCH PL STE 320
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
N CHELMSFORD
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01863-2455
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-256-1858
Provider Business Mailing Address Fax Number:
978-788-7890

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20 RESEARCH PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
N CHELMSFORD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01863-2454
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-788-7307
Provider Business Practice Location Address Fax Number:
978-788-7890
Provider Enumeration Date:
08/09/2005

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: 174400000X , with the licence number:  157601 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1639170210 . This is a "FALLON" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 3189198 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1639170210 . This is a "BMC HEALTH NET" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1639170210 . This is a "HEALTH PLANS INC" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 157601 . This is a "MEDICAL LICENSE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1639170210 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1639170210 . This is a "TUFTS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1639170210 . This is a "GREAT WEST" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1639170210 . This is a "CHAMPUS/TRICARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 37371 . This is a "HEALTHY START" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: J19862 . This is a "BCBS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1639170210 . This is a "CIGNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 45016 . This is a "FALLON" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 136878 . This is a "HEALTHSOURCE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 131062 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 157601 . This is a "TUFTS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1639170210 . This is a "PHCS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 2636907 . This is a "AETNA US HEALTHCARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0025776 . This is a "NEIGHBORHOOD HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1639170210 . This is a "HEALTHNET OF CA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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