Provider Demographics
NPI:1922083922
Name:DOMNINA, YULIYA ANATOLIEVNA (MD)
Entity Type:Individual
Prefix:DR
First Name:YULIYA
Middle Name:ANATOLIEVNA
Last Name:DOMNINA
Suffix:
Gender:F
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:PO BOX 744785
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-4785
Mailing Address - Country:US
Mailing Address - Phone:202-476-5000
Mailing Address - Fax:
Practice Address - Street 1:111 MICHIGAN AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-2916
Practice Address - Country:US
Practice Address - Phone:202-476-5000
Practice Address - Fax:704-446-1582
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2021-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA216822208000000X
NC2007-01413208000000X, 2080P0202X, 2080P0203X
DCMD0488412080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2008335Medicaid
NC5907041Medicaid
NC146Y3OtherBCBS-NC
MA216822OtherTUFTS HEALTH PLAN
SCN13008Medicaid
MAJ26173OtherBCBS OF MA
H88298Medicare UPIN
SCN13008Medicaid
MAA35628Medicare ID - Type Unspecified
NC2069283Medicare PIN