Provider Demographics
NPI:1821512591
Name:DOMINION HEALTHCARE SERVICES INC
Entity Type:Organization
Organization Name:DOMINION HEALTHCARE SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:OBENG
Authorized Official - Last Name:AWUAH
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:443-848-9123
Mailing Address - Street 1:6481 ABEL ST
Mailing Address - Street 2:
Mailing Address - City:ELKRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21075-5298
Mailing Address - Country:US
Mailing Address - Phone:443-848-9123
Mailing Address - Fax:410-796-1442
Practice Address - Street 1:6481 ABEL ST
Practice Address - Street 2:
Practice Address - City:ELKRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21075-5298
Practice Address - Country:US
Practice Address - Phone:443-848-9123
Practice Address - Fax:410-796-1442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-03
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service