Healthcare Provider Details

I. General information

NPI: 1730829367
Provider Name (Legal Business Name): JONATHAN JASON IGNACIO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2022
Last Update Date: 06/27/2025
Certification Date: 06/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1074 S STATE ST
DOVER DE
19901-6925
US

IV. Provider business mailing address

640 SOUTH STATE STREET, MAIL CODE: 3007
DOVER DE
19901
US

V. Phone/Fax

Practice location:
  • Phone: 302-725-3200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC7-0017946
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: