Provider Demographics
NPI:1548609464
Name:FANTINI, DOMENICA ALEXANDRA (DO)
Entity Type:Individual
Prefix:DR
First Name:DOMENICA
Middle Name:ALEXANDRA
Last Name:FANTINI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:DOMENICA
Other - Middle Name:ALEXANDRA
Other - Last Name:PAPARATTO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 95000 LB# 7550
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19195-7550
Mailing Address - Country:US
Mailing Address - Phone:844-362-1735
Mailing Address - Fax:973-290-7495
Practice Address - Street 1:665 MARTINSVILLE RD
Practice Address - Street 2:SUITE 218
Practice Address - City:BASKING RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07920-4700
Practice Address - Country:US
Practice Address - Phone:908-607-1877
Practice Address - Fax:908-607-1866
Is Sole Proprietor?:No
Enumeration Date:2013-06-25
Last Update Date:2018-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB09772000207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine