Organization
DAVID J DOMENICHINI MD, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID J DOMENICHINI M.D. (OWNER/PHYSICIAN)
(860) 561-1007
Entity
Organization
Contact information
Practice address
701 COTTAGE GROVE RD STE B220, BLOOMFIELD, CT 06002-3077
(860) 561-1007
(860) 561-1222
Mailing address
701 COTTAGE GROVE RD STE B220, BLOOMFIELD, CT 06002-3077
(860) 561-1007
(860) 561-1222
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
032306
CT
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
032306
CT
363L00000X
Nurse Practitioner
032306
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
500000218
MEDICAID GROUP
CT
01
—
500000332
MEDICAID APRN GROUP
CT
01
—
50DOMENICCT01
ANTHEM BLUE CROSS/ BLUE SHIELD GROUP
CT
01
—
C03887
MEDICARE GROUP
CT
01
—
DH2482
MEDICARE RAILROAD GROUP
CT
Enumeration date
11/29/2007
Last updated
05/30/2025
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