Angela P Dominique, D.P.M.
Individual provider Active NPI Podiatrist · Fultondale, AL
NPI 1508972563 · NPPES record last updated Jun 27, 2016
Key facts
- NPI
- 1508972563
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Podiatrist 213E00000X
- License
- 180 (AL)
- Practice address
- 3524 Decatur Hwy
Suite 301
Fultondale, AL 35068-1366 - Phone
- (205) 631-3699
- Fax
- (205) 631-7325
- NPI assigned
- Aug 22, 2006
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 180 | AL | MD | Podiatrist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Podiatrist | 213E00000X | 180 | AL | Yes |
Addresses
Primary practice location
3524 Decatur Hwy
Suite 301
Fultondale, AL 35068-1366
Mailing address
3524 Decatur Hwy
Suite 301
Fultondale, AL 35068-1366
Phone (205) 631-3699
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 480026565 | Other | AL | RAILROAD MEDICARE |
| 000060837 | Medicaid | AL | |
| 27-10123 | Other | AL | UNITED HEALTHCARE |
| 1536404 | Other | AL | UMWA H&R FUNDS |
| U71228 | Other | AL | VIVA HEALTH |
| 510-60837 | Other | AL | BLUE CROSS BLUE SHIELD AL |
Other providers in Fultondale, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 27, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.