Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | MD038902L | PA |
NPI | 1023012457 |
---|---|
Provider Name | Imad Domat |
First Address | Pittsburgh, PA 15232-1327 |
Second Address | Pittsburgh, PA 15232-1327 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0014146930003 | (05) | PA |
0209797000 | (05) | WV |
B41933 | (02) |