Provider Demographics
NPI:1366806481
Name:DOMICO, ADAM C (MD)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:C
Last Name:DOMICO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 2ND ST
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-2123
Mailing Address - Country:US
Mailing Address - Phone:740-373-8756
Mailing Address - Fax:
Practice Address - Street 1:611 2ND ST # C
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750-2123
Practice Address - Country:US
Practice Address - Phone:740-373-8756
Practice Address - Fax:740-373-0091
Is Sole Proprietor?:No
Enumeration Date:2016-04-06
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.138153207X00000X, 207XS0106X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery