Provider Demographics
NPI:1861535544
Name:DOMINGO, RONALDO L (MD)
Entity type:Individual
Prefix:
First Name:RONALDO
Middle Name:L
Last Name:DOMINGO
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 1:620 CHRISTIANA MED CTR
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702
Mailing Address - Country:US
Mailing Address - Phone:302-731-5548
Mailing Address - Fax:302-738-6065
Practice Address - Street 1:620 CHRISTIANA MED CTR
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19702
Practice Address - Country:US
Practice Address - Phone:302-731-5548
Practice Address - Fax:302-738-6065
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0000661207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000110601Medicaid
DE160025021Medicare PIN
DE024345Medicare PIN
DE0000110601Medicaid