Provider Demographics
NPI:1275027278
Name:DOMINIC, ANCHANA MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:ANCHANA
Middle Name:MARIE
Last Name:DOMINIC
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:500 STATE HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:OSAWATOMIE
Mailing Address - State:KS
Mailing Address - Zip Code:66064-1813
Mailing Address - Country:US
Mailing Address - Phone:137-557-0199
Mailing Address - Fax:913-755-7127
Practice Address - Street 1:500 STATE HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:OSAWATOMIE
Practice Address - State:KS
Practice Address - Zip Code:66064-1813
Practice Address - Country:US
Practice Address - Phone:913-755-7019
Practice Address - Fax:913-755-7127
Is Sole Proprietor?:No
Enumeration Date:2018-06-22
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20180218042084P0800X
KS04501972084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry