Healthcare Provider Details

I. General information

NPI: 1235125477
Provider Name (Legal Business Name): DR. DONALD JEROME MAHER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2005
Last Update Date: 08/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

181 HARTMAN BRIDGE RD
RONKS PA
17572-9700
US

IV. Provider business mailing address

181 HARTMAN BRIDGE RD
RONKS PA
17572-9700
US

V. Phone/Fax

Practice location:
  • Phone: 717-687-7541
  • Fax: 717-687-7541
Mailing address:
  • Phone: 717-687-7541
  • Fax: 717-687-7541

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License NumberDC001659L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: