Provider Demographics
NPI:1679672794
Name:DOMBROWSKI, PHILIP J (MD)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:J
Last Name:DOMBROWSKI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:25 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601-3129
Mailing Address - Country:US
Mailing Address - Phone:508-778-1829
Mailing Address - Fax:508-778-0113
Practice Address - Street 1:25 MAIN ST
Practice Address - Street 2:
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-3129
Practice Address - Country:US
Practice Address - Phone:508-778-1829
Practice Address - Fax:508-778-0113
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA544722085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1600054OtherUNITED HEALTHCARE
MA2727552001OtherCIGNA
MA1679672794OtherNETWORK HEALTH
MA6199097Medicaid
MA1679672794OtherUNICARE
MA761050OtherTUFTS
MAJ04892OtherBLUE CROSS BLUE SHIELD
MA2948032OtherAETNA
MA000000030592OtherBOSTON MEDICAL CENTER
MA940000308OtherMEDICARE ID
MA11080515OtherCAQH
MA240569OtherHARVARD PILGRIM
MA1679672794OtherGREAT WEST HEALTHCARE
MA6199097Medicaid
MA1679672794OtherUNICARE