DOMINIQUE FAYE REVAN MD
NPI 1730983727
Student in an Organized Health Care Education/Training Program in Philadelphia, PA
About Dominique Faye Revan Md NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
DOMINIQUE FAYE REVAN MD (NPI 1730983727) is an individual student in an organized health care education/training program in Philadelphia, Pennsylvania and active in the NPI registry since April 2025. She is enrolled in Medicare PECOS.
NPPES Registry Identity
Specialties & Licenses
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Dominique Faye Revan Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Other Providers at the Same Location NPPES 20
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
PHILADELPHIA, PA 19107
PHILADELPHIA, PA 19107
PHILADELPHIA, PA 19107
PHILADELPHIA, PA 19107
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Dominique Revan's NPI number?
The NPI number for Dominique Revan is 1730983727. It was assigned to this individual provider in the NPPES registry on April 1, 2025.
Where is Dominique Revan located?
Dominique Revan practices at 111 S 11th St, Philadelphia, PA 19107. The listed phone number is (215) 955-7106.
What is Dominique Revan's specialty?
The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.
Is Dominique Revan enrolled in Medicare?
Yes. Dominique Revan is registered in the Medicare PECOS enrollment system.
When was this NPI record last updated?
The NPPES record for Dominique Revan was last updated on June 13, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Dominique Faye Revan, MD · NPI 1730983727
Student in an Organized Health Care Education/Training Program provider in Philadelphia, Pennsylvania. Individual provider, active in the CMS NPPES registry since April 1, 2025.
## Identity
- **NPI:** 1730983727 (Entity type: Individual)
- **Enumerated:** April 1, 2025
- **Primary specialty:** Student in an Organized Health Care Education/Training Program · taxonomy 390200000X
- **Sole proprietor:** No
## Practice location
- **Address:** 111 S 11TH ST, Philadelphia, PA 19107-4870
- **Phone:** (215) 955-7106
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
## Record status
- **NPPES last updated:** June 13, 2026
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Source: [NPI Profile](https://npiprofile.com/npi/1730983727) · Data from the CMS NPPES public registry.