Provider Demographics
NPI:1841234580
Name:EL-KHAWAND, DOMINIQUE (MD)
Entity Type:Individual
Prefix:DR
First Name:DOMINIQUE
Middle Name:
Last Name:EL-KHAWAND
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 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-851-2443
Mailing Address - Fax:717-851-6129
Practice Address - Street 1:35 MONUMENT RD
Practice Address - Street 2:SUITE 204
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-5074
Practice Address - Country:US
Practice Address - Phone:717-851-2443
Practice Address - Fax:717-851-6129
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD440249207VF0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyFemale Pelvic Medicine and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA420283OtherUPMC
PA102837356Medicaid
PA2897369OtherHIGHMARK BLUE SHIELD
LA1065790Medicaid
LAI39616Medicare UPIN
PA2897369OtherHIGHMARK BLUE SHIELD
191801Medicare ID - Type UnspecifiedFQHC MEDICARE PROVIDER NO
PAP01355383Medicare PIN
PA291070FLTMedicare PIN