Provider Demographics
NPI:1477963676
Name:DOMINICK, ANTHONY MICHAEL (DO)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:MICHAEL
Last Name:DOMINICK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 SABIN ST
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29425-8918
Mailing Address - Country:US
Mailing Address - Phone:843-876-2813
Mailing Address - Fax:843-792-0644
Practice Address - Street 1:39 SABIN ST
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29425-8918
Practice Address - Country:US
Practice Address - Phone:843-876-2813
Practice Address - Fax:843-792-0644
Is Sole Proprietor?:No
Enumeration Date:2014-04-28
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC92498207RH0003X
NC2020-01514207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology