MEDICARE: RONALD STEVEN DOHANISH PAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	C50000507	DE

General Provider Information

NPI Number	:	1952362402
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RONALD STEVEN DOHANISH PAC

Provider Business Mailing Address
First Line	:	501 WEST 14TH ST
Second Line	:	6TH FL
City	:	WILMINGTON
State	:	DE
Zip	:	19801
Country	:	US
Telephone Number	:	302-428-6600
Fax Number	:	302-428-6750

Provider Business Practice Location Address
First Line	:	4735 OGLETOWN STANTON RD
Second Line	:	STE 2210
City	:	NEWARK
State	:	DE
Zip	:	19713
Country	:	US
Telephone Number	:	302-623-4144
Fax Number	:	302-623-4147

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/31/2006
Last Update Date	:	07/08/2007

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