Provider Demographics
NPI:1992993885
Name:DOMANSKI, MARK CHRISTIAN (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:CHRISTIAN
Last Name:DOMANSKI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:8316 ARLINGTON BLVD STE 524
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-5216
Mailing Address - Country:US
Mailing Address - Phone:703-596-1660
Mailing Address - Fax:703-646-6979
Practice Address - Street 1:8316 ARLINGTON BLVD STE 524
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-5216
Practice Address - Country:US
Practice Address - Phone:703-596-1660
Practice Address - Fax:703-646-6979
Is Sole Proprietor?:No
Enumeration Date:2007-10-04
Last Update Date:2024-01-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101257764207Y00000X, 208200000X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery