Healthcare Provider Details

I. General information

NPI: 1952362402
Provider Name (Legal Business Name): RONALD STEVEN DOHANISH PAC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4735 OGLETOWN STANTON RD STE 2210
NEWARK DE
19713
US

IV. Provider business mailing address

501 WEST 14TH ST 6TH FL
WILMINGTON DE
19801
US

V. Phone/Fax

Practice location:
  • Phone: 302-623-4144
  • Fax: 302-623-4147
Mailing address:
  • Phone: 302-428-6600
  • Fax: 302-428-6750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberC50000507
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: