Provider Demographics
NPI:1861478216
Name:DOMINICK, GERALD F (PA C)
Entity type:Individual
Prefix:MR
First Name:GERALD
Middle Name:F
Last Name:DOMINICK
Suffix:
Gender:M
Credentials:PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:667 KINGSBOROUGH SQ STE 101
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-4999
Mailing Address - Country:US
Mailing Address - Phone:757-842-4481
Mailing Address - Fax:757-466-8017
Practice Address - Street 1:113 GAINSBOROUGH SQ STE 400
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-1714
Practice Address - Country:US
Practice Address - Phone:757-842-4499
Practice Address - Fax:757-842-4490
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA219354363A00000X
VA0110000927363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP00318486OtherRR MEDICARE
VA10005129POtherOPTIMA
VA1861478216Medicaid
VA139178OtherBCBS
VA10005129POtherSENTARA
VA009140M13Medicare PIN
VAP00318486OtherRR MEDICARE