Provider Demographics
NPI:1902809197
Name:DOME, JEFFREY S (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:S
Last Name:DOME
Suffix:
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:PO BOX 37215
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21297-3215
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:111 MICHIGAN AVE NW
Practice Address - Street 2:CHILDREN'S NATIONAL MEDICAL CENTER
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-2916
Practice Address - Country:US
Practice Address - Phone:202-476-2800
Practice Address - Fax:202-476-5685
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD0363842080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3821464Medicaid
ME422400000Medicaid
MS00119084Medicaid
MI104788409Medicaid
OH2045058Medicaid
AL009912830Medicaid
WY1135554 00Medicaid
AR133502001Medicaid
LA1548669Medicaid
AZ804006Medicaid
NJ0030431Medicaid
VA010017688Medicaid
IA0527630Medicaid
TX060474601Medicaid
MO205027006Medicaid
KY64928674Medicaid
NC7612398Medicaid
TNF94483OtherUPIN
MS00119084Medicaid