Provider Demographics
NPI:1699765404
Name:DORMAN, REGINA M (MD)
Entity type:Individual
Prefix:
First Name:REGINA
Middle Name:M
Last Name:DORMAN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:3515 MASSILLON RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:UNIONTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44685-6400
Mailing Address - Country:US
Mailing Address - Phone:330-899-9350
Mailing Address - Fax:330-634-1329
Practice Address - Street 1:65 COMMUNITY RD
Practice Address - Street 2:SUITE C
Practice Address - City:TALLMADGE
Practice Address - State:OH
Practice Address - Zip Code:44278-2357
Practice Address - Country:US
Practice Address - Phone:330-633-6601
Practice Address - Fax:330-630-2941
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2017-11-30
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Provider Licenses
StateLicense IDTaxonomies
OH35071289207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2042908Medicaid
OH2042908Medicaid
OHDO0836852Medicare PIN