=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841349685
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SUSAN K JONAS MD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/10/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | J 30 OMEGA DR OMEGA PROFESSIONAL CENTER
-----------------------------------------------------
City | NEWARK
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19713
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-454-0362
-----------------------------------------------------
Fax | 302-456-9424
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | J 30 OMEGA DR OMEGA PROFESSIONAL CENTER
-----------------------------------------------------
City | NEWARK
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19713
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-454-0362
-----------------------------------------------------
Fax | 302-456-9424
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MD
-----------------------------------------------------
Name | SUSAN K JONAS
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 302-454-0362
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number | C10002323
-----------------------------------------------------
License Number State | DE
-----------------------------------------------------