Provider Demographics
NPI:1225015647
Name:VO, DOMINIQUE (MD MPH)
Entity type:Individual
Prefix:DR
First Name:DOMINIQUE
Middle Name:
Last Name:VO
Suffix:
Gender:F
Credentials:MD MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 OCEAN AVE
Mailing Address - Street 2:MGH REVERE HEALTHCARE CENTER
Mailing Address - City:REVERE
Mailing Address - State:MA
Mailing Address - Zip Code:02151
Mailing Address - Country:US
Mailing Address - Phone:781-485-6000
Mailing Address - Fax:781-485-6119
Practice Address - Street 1:300 OCEAN AVE
Practice Address - Street 2:MGH REVERE HEALTHCARE CENTER
Practice Address - City:REVERE
Practice Address - State:MA
Practice Address - Zip Code:02151-3675
Practice Address - Country:US
Practice Address - Phone:781-485-6100
Practice Address - Fax:781-485-6119
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA2085132084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry