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Individual
MARINA DOMATOVA
Active
Individual
MARINA DOMATOVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
32484
WV
207P00000X
Emergency Medicine Physician
Primary
MD486114
PA
363AM0700X
Medical Physician Assistant
012873
NY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
012873
LICENSE
NY
01
—
32484
LICENSE
WV
01
—
D0095827
LICENSE
MD
Enumeration date
07/24/2009
Last updated
01/27/2026
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