Sean D Domzalski, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

MA057321 Issued in PA

Practice address

150 Mundy Street
Mac IV Building
Wilkes-Barre, PA 18702

Phone

(570) 824-0930

Fax

(570) 824-7755

NPI assigned

Nov 21, 2014

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1416528000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1442793600000",
    "number": "1003213919",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "243 S PROSPECT ST",
            "city": "NANTICOKE",
            "state": "PA",
            "postal_code": "186342449",
            "telephone_number": "570-417-5402"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 MUNDY STREET",
            "address_2": "MAC IV BUILDING",
            "city": "WILKES-BARRE",
            "state": "PA",
            "postal_code": "18702",
            "telephone_number": "570-824-0930",
            "fax_number": "570-824-7755"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOMZALSKI",
        "first_name": "SEAN",
        "middle_name": "D",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-11-21",
        "last_updated": "2015-09-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "PA",
            "license": "MA057321",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAPITAL BLUE CROSS",
            "identifier": "50130489",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Laurel Foxworth Dodgson, MS, RPA-C
• Rachel Marie Dolk, LPC
• Passang Dolma, M.D.
• Nicole Lyn Dominick, CRNP
• Jennifer Ann Dompkosky, CRNA
• Jennielu Donlin, RN
• Donna B. McLaughlin OD
• Matthew Dooley, PSY.D.
• Jessica Doornbos, PA-C
• Michael Dopko, CRNA

• Medical Physician Assistant in Wilkes-Barre, PA
• Providers in Wilkes-Barre, PA by specialty
• Medical Physician Assistant in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.