LOUIS DOMENICO JR. (NPI# 1942380902) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1942380902 |
| Entity Type | Individual |
| Full Name | LOUIS DOMENICO JR. |
| Credential | MD |
| Practice Address |
2412-14 West Passyunk Avenue Philadelphia PA 19145-4114 |
| Mailing Address |
40 Valley Stream Pkwy Suite 100 Malvern PA 19355-1407 |
| Practice Telephone | 2154622100 |
| Practice Fax Number | 2154623100 |
| Mailing Telephone | 6106448900 |
| Enumeration Date | 2006-10-16 |
| Last Update Date | 2016-11-10 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
25MA08328500 | NJ | Allopathic & Osteopathic Physicians |
| N | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
MD426532 | PA | Allopathic & Osteopathic Physicians |
| N | 2085R0204X |
Radiology Specialization: Vascular & Interventional Radiology |
25MA08328500 | NJ | Allopathic & Osteopathic Physicians |
| Y | 2085R0204X |
Radiology Specialization: Vascular & Interventional Radiology |
MD426532 | PA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| PA | 1017778250003 | 05 | |
| NJ | 0157562 | 05 | |
| NJ | RAILROAD MEDICARE | P00823218 | 01 |
| Street Address |
2412-14 WEST PASSYUNK AVENUE |
| City | PHILADELPHIA |
| State | PA |
| Zip Code | 19145-4114 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790237501 | American Access Care of Sp Asc LLC | Clinic/Center | 2412-14 West Passyunk Avenue, Philadelphia, PA 19145-4114 | 2016-10-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518564350 | Bj's Wholesale Club Inc. | Eyewear Supplier (Equipment, not the service) | 2300a Rear W Oregon Ave, Philadelphia, PA 19145 | 2020-10-05 |
| 1376069559 | Kyle James Hughes | Physical Therapist | 2192 W Oregon Ave Fl 3, Philadelphia, PA 19145 | 2017-08-18 |
| 1821519752 | John A Takacs Dmd | Clinic/Center | 1707w Passyunk Ave, Philadelphia, PA 19145 | 2017-06-30 |
| 1033573209 | Kenneth Donahue | Dentist | 1517 Packer Avenue, Philadelphia, PA 19145 | 2016-04-13 |
| 1437516895 | Kimberly Wyand | Physical Therapist | 2129 Oregon St, Philadelphia, PA 19145 | 2016-01-15 |
| 1760856538 | Liji Vipin | Nurse Practitioner | 1615 Oregon Ave, Philadelphia, PA 19145 | 2015-11-17 |
| 1528333846 | Gina Marie Doyle | Registered Nurse | 1930 S. Broad Street, Philadelphia, PA 19145 | 2012-03-20 |
| 1639446214 | Thao T Tran | Pharmacist | 2014-24 South Broad St, Philadelphia, PA 19145 | 2011-11-25 |
| 1649573171 | Phyllis Yang | Internal Medicine | 1700 S Broad St, Unit 201, Philadelphia, PA 19145 | 2010-12-05 |
| 1326364613 | South Philadelphia Open Mri, LLC | Clinic/Center | 1834 West Oregon Avenue, Philadelphia, PA 19145 | 2010-04-13 |
| Find all providers in zip 19145 | ||||
| Taxonomy Code | 2085R0204X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Vascular & Interventional Radiology |
| A radiologist who diagnoses and treats diseases by various radiologic imaging modalities. These include fluoroscopy, digital radiography, computed tomography, sonography and magnetic resonance imaging. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Radiology, 2007. http://www.theabr.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Radiology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184854531 | John Yoon | Radiology | 9 N 9th St Unit 510, Philadelphia, PA 19107-3154 | 2009-07-20 |
| 1144423096 | Jonathan Ira Lieberman | Radiology | 1016 Chestnut St, Thomas Jefferson University Hospital, Philadelphia, PA 19107-5010 | 2007-06-07 |
| 1336188945 | David R. Hertzog | Radiology | 2412 W Passyunk Ave, Philadelphia, PA 19145-4114 | 2006-06-06 |
| 1760441760 | James Frederick Mcguckin Jr. | Radiology | 2929 Arch Street, Suite 1705, Philadelphia, PA 19104-2866 | 2006-03-20 |
| 1588639819 | American Access Care of Sp LLC | Radiology | 2412-14 West Passyunk Ave., Philadelphia, PA 19145-4114 | 2006-02-21 |
| 1104816453 | Huynh Doan | Radiology | Broad & Vine St, Philadelphia, PA 19102 | 2005-10-27 |
| 1174513105 | Mark Hysell | Radiology | Broad & Vine St S, Philadelphia, PA 19102 | 2005-10-21 |
| 1699774257 | Image Guided Surgery Associates, PC | Radiology | 5735 Ridge Ave, Ste 106, Philadelphia, PA 19128-1745 | 2005-07-17 |
| 1033753405 | Stc Pediatrics LLC | Radiology | 160 E Erie Ave, Philadelphia, PA 19134-1011 | 2019-10-29 |
| 1033670153 | Jung Hyun Yun | Radiology | 5501 Old York Road, Philadelphia, PA 19141 | 2019-03-29 |
| Find all providers in PHILADELPHIA | ||||
| City | PHILADELPHIA |
| Zip Code | 19145 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.