Domeracki, Gary F

Domeracki, Gary F is an individual health care provider with primary practice located at 3401 N Broad St 6Th Fl Parkinson Pavilion, Philadelphia PA 19140-5103. He recently has only one registered license in Allopathic & Osteopathic Physicians / Ophthalmology, which is considered as his primary health care specialty. Domeracki, Gary F can be contacted via phone (215) 707-3185.

Contact Information

Primary practice address
3401 N Broad St 6Th Fl Parkinson Pavilion Philadelphia PA 19140-5103
Phone: (215) 707-3185
Fax: (215) 707-1684
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Ophthalmology 207W00000X MD063291L Pennsylvania

Profile Details

NPI number 1558359471
LBN Legal business name Domeracki, Gary F
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 13th, 2005
Last updated Mar 21st, 2017 - about 8 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1558359471 NPPES
Pennsylvania MEDICAID 00178192300012

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