Provider Demographics
NPI:1831639202
Name:GREGORY, DOMINIC
Entity Type:Individual
Prefix:
First Name:DOMINIC
Middle Name:
Last Name:GREGORY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3533 E CAPITOL ST SE
Mailing Address - Street 2:APT 101
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20019-1208
Mailing Address - Country:US
Mailing Address - Phone:202-883-1487
Mailing Address - Fax:
Practice Address - Street 1:3533 E CAPITOL ST SE
Practice Address - Street 2:APT 101
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-1208
Practice Address - Country:US
Practice Address - Phone:202-883-1487
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-03
Last Update Date:2017-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide