Dr. Mary Ann R Domingo
Rheumatology
6901 N Main St Ste 102
Granger
, Indiana 46530-8022
Dr. Mary Ann R Domingo
Rheumatology
6901 N Main St Ste 102
Granger
, Indiana 46530-8022
(574) 647-1610
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About
Features
Specialties
- Rheumatology
Languages spoken
- English
Location
First Address
- Dr. Mary Ann R Domingo
- 710 N Niles Ave
- South Bend, IN
- Zip : 46617-1924
- Phone : (574) 647-1610
Second Address
- Dr. Mary Ann R Domingo
- 6901 N Main St Ste 102
- Granger, IN
- Zip : 46530-8022
- Fax : (574) 647-6354
- Phone : (574) 647-4500
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 207RR0500X | Rheumatology | 01061323A | IN |
National Provider Identifier
| NPI | 1053396127 |
|---|---|
| Provider Name | Dr. Mary Ann R Domingo |
| First Address | South Bend, IN 46617-1924 |
| Second Address | Granger, IN 46530-8022 |
| Gender | F |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 13/12/2005 |
| Last Update Date | 01/04/2021 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 000000803598 | BCBS MAIN STREET (01) | IN |
| 200537970 | (05) | IN |
| H38014 | (02) | IN |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.