Provider Demographics
NPI:1083691356
Name:DOMANSKI, JEREMY PETER (MD)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:PETER
Last Name:DOMANSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:112 GAINSBOROUGH SQ
Mailing Address - Street 2:STE 200
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-1706
Mailing Address - Country:US
Mailing Address - Phone:757-547-0798
Mailing Address - Fax:757-547-0145
Practice Address - Street 1:112 GAINSBOROUGH SQ
Practice Address - Street 2:STE 200
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-1706
Practice Address - Country:US
Practice Address - Phone:757-547-0798
Practice Address - Fax:757-547-0145
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
HIMD-14256207RG0100X
VA0101259433207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology