GARY F DOMERACKI (NPI# 1558359471) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1558359471 |
| Entity Type | Individual |
| Full Name | GARY F DOMERACKI |
| Credential | MD |
| Practice Address |
3401 N Broad St 6th Fl Parkinson Pavilion Philadelphia PA 19140-5103 |
| Mailing Address |
2450 W Hunting Park Ave Philadelphia PA 19129-1302 |
| Practice Telephone | 2157073185 |
| Practice Fax Number | 2157071684 |
| Mailing Telephone | 2157073185 |
| Mailing Fax Number | 2157071684 |
| Enumeration Date | 2005-10-13 |
| Last Update Date | 2017-03-21 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207W00000X | Ophthalmology | MD063291L | PA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| PA | 00178192300012 | 05 |
| Street Address |
3401 N BROAD ST 6TH FL PARKINSON PAVILION |
| City | PHILADELPHIA |
| State | PA |
| Zip Code | 19140-5103 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942205133 | Shefali Agrawal | Specialist | 3401 N Broad St, Philadelphia, PA 19140-5103 | 2005-06-15 |
| 1962018523 | Caroline Grace Kelly | Audiologist | 3401 N Broad St, Philadelphia, PA 19140-5189 | 2020-09-18 |
| 1457965964 | Barbara Ohiaeri | Pharmacist | 3401 N Broad St, Philadelphia, PA 19140-5103 | 2020-09-02 |
| 1710505904 | Cara Greenspan | 3401 N Broad St, Philadelphia, PA 19140-5103 | 2020-07-14 | |
| 1013535756 | Srinivasa Prasad Venkata Kanuparthi | Neurological Surgery | 3401 N Broad St, Philadelphia, PA 19140-5189 | 2020-07-09 |
| 1417575143 | Sakshi Gandhi | Internal Medicine | 3401 N Broad St, Philadelphia, PA 19140-5189 | 2020-07-09 |
| 1801414594 | Azka Rahman | Internal Medicine | 3401 N Broad St, Philadelphia, PA 19140-5103 | 2020-07-08 |
| 1417574658 | Anna-kaye Marie Brown | Anesthesiology | 3401 N Broad St, Philadelphia, PA 19140-5189 | 2020-07-04 |
| 1285251405 | Shalonda Cook | Internal Medicine | 3401 N Broad St, Philadelphia, PA 19140-5103 | 2020-07-03 |
| 1386261501 | Temidayo Aderibigbe | Orthopaedic Surgery | 3401 N Broad St, Philadelphia, PA 19140-5103 | 2020-07-03 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225640519 | Desirea Grant | Registered Nurse | 2000 W. Venango Street, Phila, PA 19140 | 2020-08-19 |
| 1306316104 | Carmen Doumit | Dentist | 3223 N Broad Street, Temple University Department of Orthodontics, Philadelphia, PA 19140 | 2018-12-05 |
| 1780150375 | Samantha Marina Felix | Counselor | 3803-3805 N 5th St, Philadelphia, PA 19140 | 2018-10-22 |
| 1518485135 | Holly Marie Barbee | Dietitian, Registered | 4417 N 6th St., Philadelphia, PA 19140 | 2017-09-04 |
| 1033630892 | Jessica Anne Tang | Otolaryngology | 3440 North Broad Street, Kresge West #300, Philadelphia, PA 19140 | 2017-07-03 |
| 1710416870 | Narsis Aminian | Internal Medicine | 3401 N Broad Street, Temple Hospital, Neurlogy Deartment, Philadelphia, PA 19140 | 2017-06-12 |
| 1629527338 | Alaa Khatib | Pharmacist | 4616-4650 N. Broad Street, Philadelphia, PA 19140 | 2016-09-23 |
| 1548716160 | Direct Home Health Care | In Home Supportive Care | 3550 N 9th St, Philadelphia, PA 19140 | 2016-09-01 |
| 1306399225 | Zaima Choudhry | Student in an Organized Health Care Education/Training Program | Department of Pulmonary and Sleep Medicine, 3401 North Broad Street, Zone C - 7th Floor, Philadelphia, PA 19140 | 2016-07-27 |
| 1891145504 | Saji Mathew | Pharmacist | 4530n 5th Street, Philadelphia, PA 19140 | 2016-06-14 |
| Find all providers in zip 19140 | ||||
| Taxonomy Code | 207W00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Ophthalmology |
| An ophthalmologist has the knowledge and professional skills needed to provide comprehensive eye and vision care. Ophthalmologists are medically trained to diagnose, monitor and medically or surgically treat all ocular and visual disorders. This includes problems affecting the eye and its component structures, the eyelids, the orbit and the visual pathways. In so doing, an ophthalmologist prescribes vision services, including glasses and contact lenses. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Ophthalmology, 2007. http://www.abop.org/. American Osteopathic Board of Ophthalmology and Otolaryngology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Ophthalmology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Ophthalmology and Otolaryngology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386256782 | Maria Manquez Hatta | Ophthalmology | 840 Walnut St Fl 14, Philadelphia, PA 19107-5109 | 2020-08-18 |
| 1821640459 | Stephanie Nicole Kletke | Ophthalmology | 3500 Civic Center Blvd Fl 11, Philadelphia, PA 19104-4395 | 2019-07-13 |
| 1083105654 | Shuai-chun Lin | Ophthalmology | 5401 Old York Rd Ste 205, Philadelphia, PA 19141-3044 | 2018-05-19 |
| 1285188383 | Imran Jivraj | Ophthalmology | 3737 Chestnut St, Apt 809, Philadelphia, PA 19104-7702 | 2016-08-08 |
| 1063851160 | Durga Borkar | Ophthalmology | 840 Walnut St Ste 1020, Philadelphia, PA 19107-5109 | 2013-06-21 |
| 1205275922 | Katherine Elizabeth Uyhazi | Ophthalmology | 3801 Filbert St Ste 515, Philadelphia, PA 19104 | 2013-06-15 |
| 1548605231 | Avni Umesh Badami | Ophthalmology | 51 N 39th St Ste 515, Philadelphia, PA 19104-2640 | 2013-05-08 |
| 1063755361 | Alison Blair Huggins Watson | Ophthalmology | 840 Walnut St Ste 910, Philadelphia, PA 19107-5109 | 2013-04-04 |
| 1447509807 | William Alan Raich | Ophthalmology | 210 Locust St, Apt. 19ab, Philadelphia, PA 19106-3934 | 2012-08-31 |
| 1780955575 | Collazo Ophthalmology & Optometry | Ophthalmology | 4231 N 5th St, Philadelphia, PA 19140-2602 | 2012-01-25 |
| Find all providers in PHILADELPHIA | ||||
| City | PHILADELPHIA |
| Zip Code | 19140 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.