Provider Demographics
NPI:1225046808
Name:VINH, DOMINIQUE (MD)
Entity Type:Individual
Prefix:
First Name:DOMINIQUE
Middle Name:
Last Name:VINH
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 1:22575 LEANNE TERRACE
Mailing Address - Street 2:UNIT 426
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20148-6825
Mailing Address - Country:US
Mailing Address - Phone:703-909-1882
Mailing Address - Fax:
Practice Address - Street 1:333 W CORK ST
Practice Address - Street 2:SUITE 720
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-3870
Practice Address - Country:US
Practice Address - Phone:540-536-5121
Practice Address - Fax:540-536-5129
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2012-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-114545207R00000X, 208100000X
VA0101047558208100000X, 2081P0004X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No2081P0004XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSpinal Cord Injury Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1225046808Medicaid
VA1225046808Medicaid