Provider Demographics
NPI:1750695151
Name:DOMINGUE, DORIS (ARDMS)
Entity type:Individual
Prefix:
First Name:DORIS
Middle Name:
Last Name:DOMINGUE
Suffix:
Gender:F
Credentials:ARDMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 GRASSHOPPER LN
Mailing Address - Street 2:
Mailing Address - City:GREENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18426-7449
Mailing Address - Country:US
Mailing Address - Phone:570-814-3009
Mailing Address - Fax:
Practice Address - Street 1:130 GRASSHOPPER LN
Practice Address - Street 2:
Practice Address - City:GREENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18426-7449
Practice Address - Country:US
Practice Address - Phone:570-814-3009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-28
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA40662471S1302X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonography