Provider Demographics
NPI:1972639078
Name:DOMER, DANA J (PA)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:J
Last Name:DOMER
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:7614 KNOLL RIDGE AVE NE
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44721
Mailing Address - Country:US
Mailing Address - Phone:330-324-3010
Mailing Address - Fax:330-491-1681
Practice Address - Street 1:4650 HILLS AND DALES RD NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44708-6220
Practice Address - Country:US
Practice Address - Phone:330-491-9675
Practice Address - Fax:330-491-1682
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2013-07-24
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Provider Licenses
StateLicense IDTaxonomies
OH50001082363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant