Provider Demographics
NPI:1528787413
Name:LEMELLE BALTIMORE, DOMINQUE COURTNEY
Entity type:Individual
Prefix:
First Name:DOMINQUE
Middle Name:COURTNEY
Last Name:LEMELLE BALTIMORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 HAMILTON CIR
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17111-3533
Mailing Address - Country:US
Mailing Address - Phone:717-982-3185
Mailing Address - Fax:
Practice Address - Street 1:1101 HAMILTON CIR
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17111-3533
Practice Address - Country:US
Practice Address - Phone:717-982-3185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health