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General NPI Number Information
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NPI Number | 1457534364
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Entity Type | Individual
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Provider Name | KENNETH D DOTSON RPA-C
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Gender | Male
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Dates
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Enumeration Date | 12/13/2007
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Last Update Date | 09/26/2014
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Provider Practice Location Address
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Address Line | 206 E BROWN ST
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City | EAST STROUDSBURG
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State | PA
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Zip | 18301-3006
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Country | US
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Telephone | 570-421-4000
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Fax |
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Provider Business Mailing Address
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Address Line | 2407 MOUNTAIN RD
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City | STROUDSBURG
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State | PA
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Zip | 18360-6708
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Country | US
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Telephone | 570-856-6200
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Fax | 570-445-4553
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | MA051281
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License Number State | PA
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