Dr. Liezl Tersol Domingo

M.D. | Pediatric Cardiology | Female

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Complete Profile:

Dr. Liezl Tersol Domingo basic information including her official name, gender, specialization, credentials etc. are as mentioned below.

Specialization :	Pediatrics Pediatric Cardiology
Provider Name :	Dr. Liezl Tersol Domingo
Credential :	M.D.
Gender :	Female

Business Address:

Dr. Liezl Tersol Domingo address, contact phone number and fax are as below. Patients can directly walkin to the clinic or can call on the below given phone number for appointment.

Primary Address :	1120 15th St Augusta, GA, 30912-7232 United States
Phone Number :	706-721-8623

Professional Identification Codes:

NPI number stands for National Provider Identifier which is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS). NPI details are as mentioned below.

NPI Number :	1871880849
NPI Entity Type :	Individual
First Enrolment Date :	28 Jun, 2011
Last Updated On :	20 Dec, 2021

Medicare Participation:

Dr. Liezl Tersol Domingo participates in medicare and accepts medicare insurance either directly or through association with group practice or medical facility.

Medicare PECOS ID :	7517184930
Medicare Enrollment ID :	I20211213000118
Primary Specialty :	Pediatric Medicine
Medical School :	Other
Graduation Year :	2005
Accepts Medicare?	Yes. Dr. Liezl Tersol Domingo accepts medicare insurance.

Group Practice Association:

Dr. Liezl Tersol Domingo is associated with following Group Practice Organizations. Group practices are practice of medicine by a group of physicians who share their premises and other resources. Following list states all the group name with which Dr. Liezl Tersol Domingo is associated with along with the number of members in that group. She may also accept medicare indirectly via these group practices.

Organisation Name :	Group Practice ID	No. of Members	Practice Address	Group Accepts Medicare
University Of Utah Pediatric Services	0547552473	52	81 N Mario Capecchi Dr Salt Lake City, UT - 841131125 Ph: 8012133599	Yes

Licenses and Specialities:

Physicians/Organizations can have one or more medical licenses for different specialities in the same state or different states. Related medical licenses for Dr. Liezl Tersol Domingo are as mentioned. Primary taxonomy code for Dr. Liezl Tersol Domingo, M.D. is 2080P0202X (Pediatrics Pediatric Cardiology).

Taxonomy Code	Speciality	Primary	License No.	State
2080P0202X	Pediatrics Pediatric Cardiology	Yes	079825	GA
390200000X	Student in an Organized Health Care Education/Training Program	No

Other Practice Locations:

Practice Address	City, State	Phone Number
1740 W TAYLOR ST, CHICAGO, IL, 60612-7232 United States	CHICAGO, IL	866-600-2273

Endpoints:

Endpoints provide a simple, secure, scalable, and standards-based way for participants to send authenticated, encrypted health information directly to known, trusted recipients over the Internet. It is used by EHR systems (Electronic Health Records).

Mailing Address:

Mailing address can be used for mailing purpose only, for visiting purpose patients need to refer above mentioned business address only.

Mailing Address :	1499 Walton Way Ste 1400 Augusta, GA, 30901-2603 United States
Phone Number :	706-724-6100

Business Location:

Patients can refer following map for directions to Dr. Liezl Tersol Domingo practice address. Don't forget to take prior appointment before visiting.
** Data of this site is collected from Medicare & Medicaid Services (CMS) and NPPES.