Provider Demographics
NPI:1588874283
Name:DOMBROSKI, SCOTT MICHAEL (PA-C)
Entity type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:MICHAEL
Last Name:DOMBROSKI
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:472 POLARIS AVE
Mailing Address - Street 2:VIRGINIA BEACH VA
Mailing Address - City:FPO
Mailing Address - State:AA
Mailing Address - Zip Code:23461
Mailing Address - Country:US
Mailing Address - Phone:757-862-0077
Mailing Address - Fax:
Practice Address - Street 1:472 POLARIS AVE
Practice Address - Street 2:VIRGINIA BEACH VA
Practice Address - City:FPO
Practice Address - State:AA
Practice Address - Zip Code:23461
Practice Address - Country:US
Practice Address - Phone:910-449-2653
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant