Provider Demographics
NPI:1760527576
Name:DOMM, AARON BENJAMIN (MD)
Entity Type:Individual
Prefix:DR
First Name:AARON
Middle Name:BENJAMIN
Last Name:DOMM
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:PO BOX 530062
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30353-0062
Mailing Address - Country:US
Mailing Address - Phone:843-695-6071
Mailing Address - Fax:843-569-5879
Practice Address - Street 1:5500 FRONT ST # 260
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29486-7735
Practice Address - Country:US
Practice Address - Phone:843-376-0670
Practice Address - Fax:843-376-0669
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC29748207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCP01058405OtherRR MEDICARE
SC297486Medicaid
SCAA19027006Medicare PIN
SCAA19026834Medicare PIN
SC297486Medicaid