Individual
DR. DOMINIC T. HAYNESWORTH SR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2351 E 22ND ST, CLEVELAND, OH 44115-3111
(216) 861-6200
Mailing address
3620 LANGTON RD, CLEVELAND, OH 44121-1323
Taxonomy
Speciality
Code
Description
License number
State
146D00000X
Personal Emergency Response Attendant
35046582
OH
207P00000X
Emergency Medicine Physician
Primary
46583
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0464939
—
OH
01
—
942460636429
CARESOURCE
OH
Enumeration date
06/01/2006
Last updated
08/10/2021
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