Provider Demographics
NPI:1023180932
Name:DONLICK, ROBERT C (DO)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:C
Last Name:DONLICK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1145
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:DE
Mailing Address - Zip Code:19938-1145
Mailing Address - Country:US
Mailing Address - Phone:302-653-8916
Mailing Address - Fax:302-653-7320
Practice Address - Street 1:210 CLAYTON AVENUE
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:DE
Practice Address - Zip Code:19938-1145
Practice Address - Country:US
Practice Address - Phone:302-653-8916
Practice Address - Fax:302-653-7320
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2014-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC20000456207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE013497088OtherMEDICARE RAILROAD
DE044079Medicare PIN