Provider Demographics
NPI:1982687513
Name:DOMSON, PAUL C SR (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:C
Last Name:DOMSON
Suffix:SR
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 1:9135 PISCATAWAY RD
Mailing Address - Street 2:SUITE 240
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-2549
Mailing Address - Country:US
Mailing Address - Phone:301-868-3474
Mailing Address - Fax:301-868-0026
Practice Address - Street 1:9135 PISCATAWAY RD
Practice Address - Street 2:SUITE 240
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-2549
Practice Address - Country:US
Practice Address - Phone:301-868-3474
Practice Address - Fax:301-868-0026
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0014872208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics