| Doctor Name: | GREGORY S DOMER |
| NPI Number: | 1003872474 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | MD427177 |
| Business Practice Address: | One Medical Center Blvd Suite 233 Upland, PA - 19013 |
| Business Phone Number: | 6104990400 |
| Business Fax Number: | 6104991970 |
| Mailing Address: | One Medical Center Blvd, Suite 233 UPLAND |
| State: | PA |
| Postal Code: | 190133902 |
| Phone Number: | 6104990400 |
| Fax Number: | 6104991970 |
| NPI Enumeration Date: | 04/25/2006 |
| NPI Last Update Date: | 11/02/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2086S0129X |
| License Number: | MD427177 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | PA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Surgery |
| Taxonomy Specialization: | Vascular Surgery |
| Taxonomy Definition: | A surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart. |