Provider Demographics
NPI:1861131898
Name:COLVARD, DOMINIQUE MARIA (PA)
Entity type:Individual
Prefix:
First Name:DOMINIQUE
Middle Name:MARIA
Last Name:COLVARD
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:DOMINIQUE
Other - Middle Name:MARIA
Other - Last Name:WASHINGTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:42 NASHUA ROAD
Mailing Address - Street 2:
Mailing Address - City:LONDONDERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03053
Mailing Address - Country:US
Mailing Address - Phone:603-413-6800
Mailing Address - Fax:603-413-6803
Practice Address - Street 1:42 NASHUA ROAD
Practice Address - Street 2:
Practice Address - City:LONDONDERRY
Practice Address - State:NH
Practice Address - Zip Code:03053
Practice Address - Country:US
Practice Address - Phone:603-413-6800
Practice Address - Fax:603-413-6803
Is Sole Proprietor?:No
Enumeration Date:2022-05-28
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant