Provider Demographics
NPI:1346223971
Name:DOMSON, JOANNE FROIO (MD)
Entity type:Individual
Prefix:MS
First Name:JOANNE
Middle Name:FROIO
Last Name:DOMSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:702 FORDS LANDING WAY
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-3886
Mailing Address - Country:US
Mailing Address - Phone:703-548-4844
Mailing Address - Fax:
Practice Address - Street 1:9135 PISCATAWAY RD
Practice Address - Street 2:SUITE 215
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-2549
Practice Address - Country:US
Practice Address - Phone:301-868-9313
Practice Address - Fax:301-868-0026
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0014502207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
00A362A24Medicare PIN
MDB93473Medicare UPIN
017M729EMedicare PIN