Individual
JUSTIN DOMURAT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
7401 GREENBELT RD, GREENBELT, MD 20770-3402
(301) 982-5437
Mailing address
1 HOLLOW LN STE 301, NEW HYDE PARK, NY 11042-1215
(516) 869-0650
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
61214691
WA
Other
Enumeration date
12/05/2021
Last updated
12/05/2021
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