Provider Demographics
NPI:1871031492
Name:DEDOMINICIS, FRANKLIN (PA-C)
Entity Type:Individual
Prefix:
First Name:FRANKLIN
Middle Name:
Last Name:DEDOMINICIS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1952 WHITNEY AVE STE 8
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06517-1209
Mailing Address - Country:US
Mailing Address - Phone:203-848-1803
Mailing Address - Fax:203-848-1777
Practice Address - Street 1:1952 WHITNEY AVE STE 8
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06517-1209
Practice Address - Country:US
Practice Address - Phone:203-848-1803
Practice Address - Fax:203-848-1777
Is Sole Proprietor?:No
Enumeration Date:2017-02-02
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT23.003773363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant