Provider Demographics
NPI:1902673437
Name:DOMINION HEALTHCARE SERVICES INC
Entity Type:Organization
Organization Name:DOMINION HEALTHCARE SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:MERCY
Authorized Official - Middle Name:
Authorized Official - Last Name:NGEUSANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-848-9123
Mailing Address - Street 1:3455 WILKENS AVE STE 208
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21229-5265
Mailing Address - Country:US
Mailing Address - Phone:667-260-6027
Mailing Address - Fax:667-260-6028
Practice Address - Street 1:3455 WILKENS AVE STE 208
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21229-5265
Practice Address - Country:US
Practice Address - Phone:667-260-6027
Practice Address - Fax:667-260-6028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-05
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)