Provider Demographics
NPI:1891718185
Name:AVIADO, DOMINGO G (MD)
Entity Type:Individual
Prefix:DR
First Name:DOMINGO
Middle Name:G
Last Name:AVIADO
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 1:250 CHAMBERS BRIDGE ROAD
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08723
Mailing Address - Country:US
Mailing Address - Phone:732-771-2222
Mailing Address - Fax:732-771-2223
Practice Address - Street 1:250 CHAMBERS BRIDGE ROAD
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08723
Practice Address - Country:US
Practice Address - Phone:732-771-2222
Practice Address - Fax:732-771-2223
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10004793207Q00000X
NJ25MA10191700207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE000719701Medicaid
491347Medicare PIN
E66332Medicare UPIN