# WAYNE D DOMIN

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1568427912
- **Gender:** Man
- **Credential:** MD

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207V00000X | Obstetrics & Gynecology Physician | 6193 | NH | Yes |

## Other

- **Enumeration date:** 04/19/2006
- **Last updated:** 09/01/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 00000575 | — | NH |
| 01 | — | 0105602YONH01 | ANTHEM | NH |
| 01 | — | 020346032 | TAX ID | — |
| 05 | — | 81166895 | — | NH |