Provider Demographics
NPI:1962713370
Name:DOMINGUES, ERIK (MD)
Entity type:Individual
Prefix:DR
First Name:ERIK
Middle Name:
Last Name:DOMINGUES
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 1:10 N MAIN ST STE 402
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02720-2130
Mailing Address - Country:US
Mailing Address - Phone:508-974-3037
Mailing Address - Fax:
Practice Address - Street 1:10 N MAIN ST STE 402
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-2130
Practice Address - Country:US
Practice Address - Phone:508-974-3037
Practice Address - Fax:434-423-4783
Is Sole Proprietor?:No
Enumeration Date:2010-06-30
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD16925207N00000X
MA257696207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIED97325Medicaid
MA110100236AMedicaid
MAS400153681Medicare PIN