Provider Demographics
NPI:1801195482
Name:FEMIANO, DOMINIC J (MD)
Entity Type:Individual
Prefix:
First Name:DOMINIC
Middle Name:J
Last Name:FEMIANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3800 MONTLAKE BLVD
Mailing Address - Street 2:BOX 354060
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98195-4060
Mailing Address - Country:US
Mailing Address - Phone:206-520-5000
Mailing Address - Fax:206-598-3140
Practice Address - Street 1:3800 MONTLAKE BLVD
Practice Address - Street 2:BOX 354060
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98195-4060
Practice Address - Country:US
Practice Address - Phone:206-520-5000
Practice Address - Fax:206-598-3140
Is Sole Proprietor?:No
Enumeration Date:2011-03-21
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD 60393394207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine