Individual
DOMINIC J MAXWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
15 CHURCH ST, VINEYARD HAVEN, MA 02568
(508) 687-9592
(508) 687-9567
Mailing address
10 CANTERBURY LN, VINEYARD HAVEN, MA 02568-5658
(508) 687-9592
(508) 687-9567
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
00025983
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009933454
—
AL
01
—
051530946
BC BS OF AL
AL
Enumeration date
05/08/2006
Last updated
06/23/2011
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