Provider Demographics
NPI:1023012457
Name:DOMAT, IMAD (MD)
Entity Type:Individual
Prefix:
First Name:IMAD
Middle Name:
Last Name:DOMAT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 DAUGHERTY DR STE 301
Mailing Address - Street 2:
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146-2749
Mailing Address - Country:US
Mailing Address - Phone:412-856-4666
Mailing Address - Fax:412-856-6907
Practice Address - Street 1:532 S AIKEN AVE STE 411
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15232-1521
Practice Address - Country:US
Practice Address - Phone:412-681-3140
Practice Address - Fax:412-681-2561
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD038902L207RI0011X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0209797000Medicaid
PA0014146930007Medicaid
454953Medicare ID - Type Unspecified
WV0209797000Medicaid