Provider Demographics
NPI:1790748085
Name:ADOMONIS, HENRY JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:JOHN
Last Name:ADOMONIS
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 1:12200 LOCKHART LN
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614-9405
Mailing Address - Country:US
Mailing Address - Phone:919-608-1929
Mailing Address - Fax:
Practice Address - Street 1:5400 S MIAMI BLVD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27703-8465
Practice Address - Country:US
Practice Address - Phone:919-941-1911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-09
Last Update Date:2024-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCF94342Medicare UPIN