Individual
THOMAS M DOMANICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.P,M,
Contact information
Practice address
1825 BARNUM AVE, STRATFORD, CT 06614-5333
(203) 377-1777
Mailing address
2660 MAIN ST, SUITE 216, BRIDGEPORT, CT 06606-5369
(203) 377-1777
Taxonomy
Speciality
Code
Description
License number
State
213EP1101X
Primary Podiatric Medicine Podiatrist
Primary
P00289
CT
213ES0131X
Foot Surgery Podiatrist
P00289
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004051868
—
CT
01
—
004144309
MEDICAID DME
CT
01
—
0071014
AETNA
CT
01
—
030000289CT02
ANTHEM BC/BS
CT
01
—
0V2746
HEALTH NET
CT
01
—
ZS701
OXFORD
CT
Enumeration date
06/16/2006
Last updated
01/07/2015
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