Individual
WAYNE D DOMIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
96 HIGH STREET, LACONIA, NH 03246-3537
(603) 524-9197
(603) 524-9142
Mailing address
PO BOX 310, LACONIA, NH 03247-0310
(603) 524-3211
(603) 527-7038
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
6193
NH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00000575
—
NH
01
—
0105602YONH01
ANTHEM
NH
01
—
020346032
TAX ID
—
05
—
81166895
—
NH
Enumeration date
04/19/2006
Last updated
09/01/2011
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