Individual
LOUIS DOMENICO JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2412-14 WEST PASSYUNK AVENUE, PHILADELPHIA, PA 19145-4114
(215) 462-2100
(215) 462-3100
Mailing address
PO BOX 416147, BOSTON, MA 02241-6147
(610) 644-8900
(484) 924-0053
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
25MA08328500
NJ
2085R0202X
Diagnostic Radiology Physician
MD426532
PA
2085R0204X
Vascular & Interventional Radiology Physician
25MA08328500
NJ
2085R0204X
Vascular & Interventional Radiology Physician
Primary
MD426532
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0157562
—
NJ
05
—
1017778250003
—
PA
01
—
P00823218
RAILROAD MEDICARE
NJ
Enumeration date
10/16/2006
Last updated
02/18/2021
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