Provider Demographics
NPI:1518643378
Name:DOMINIANNI, ALEXANDRA NICOLE (MD)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDRA
Middle Name:NICOLE
Last Name:DOMINIANNI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:96 JONATHAN LUCAS STREET
Mailing Address - Street 2:MSC 613
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29425
Mailing Address - Country:US
Mailing Address - Phone:843-792-2098
Mailing Address - Fax:
Practice Address - Street 1:96 JONATHAN LUCAS STREET
Practice Address - Street 2:MSC 613
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29425
Practice Address - Country:US
Practice Address - Phone:843-792-2098
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-26
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL903252086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery