Provider Demographics
NPI:1528028883
Name:DOMINICK, THOMAS F (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:F
Last Name:DOMINICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1 HOSPITAL DR STE 306
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17837-9350
Mailing Address - Country:US
Mailing Address - Phone:570-522-4110
Mailing Address - Fax:570-768-3911
Practice Address - Street 1:210 JPM RD STE 300
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:PA
Practice Address - Zip Code:17837-9367
Practice Address - Country:US
Practice Address - Phone:570-524-4446
Practice Address - Fax:570-768-4623
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2022-06-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD054208L207XS0114X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAG44728Medicare UPIN