Individual
DR. LOUIS JOSEPH DOMENICI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
22 S GREENE ST, BALTIMORE, MD 21201-1544
(410) 328-8769
(410) 328-3577
Mailing address
PO BOX 64442, BALTIMORE, MD 21264-4442
(410) 328-8769
(410) 328-3577
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
D22422
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
309570-02
BLUE CROSS/BLUE SHIELD
MD
05
—
375781100
—
MD
05
—
3810000274
—
WV
01
—
525249-04
BLUE CROSS/BLUE SHIELD
MD
05
—
5850681
—
VA
Enumeration date
05/05/2006
Last updated
11/22/2010
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