Basic Information
| Provider Information | |||||||||
| NPI: | 1922083922 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DOMNINA | ||||||||
| FirstName: | YULIYA | ||||||||
| MiddleName: | ANATOLIEVNA | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 744785 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303744785 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2024765000 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 111 MICHIGAN AVE NW | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200102916 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2024765000 | ||||||||
| FaxNumber: | 7044461582 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/13/2005 | ||||||||
| LastUpdateDate: | 03/07/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/07/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 216822 | MA | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | 2007-01413 | NC | N | Allopathic & Osteopathic Physicians | Pediatrics | 2080P0202X | 2007-01413 | NC | N | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Cardiology | 2080P0203X | 2007-01413 | NC | N | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Critical Care Medicine | 2080P0203X | MD048841 | DC | Y | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Critical Care Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2008335 | 05 | MA | MEDICAID | 5907041 | 05 | NC | MEDICAID | 146Y3 | 01 | NC | BCBS-NC | OTHER | 216822 | 01 | MA | TUFTS HEALTH PLAN | OTHER | N13008 | 05 | SC | MEDICAID | J26173 | 01 | MA | BCBS OF MA | OTHER |