Provider Demographics
NPI:1235464983
Name:JASKEWICH, RICHARD PAUL (PHYSCIAN ASSISTANT)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:PAUL
Last Name:JASKEWICH
Suffix:
Gender:M
Credentials:PHYSCIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5409 DELRAY DRIVE
Mailing Address - Street 2:FAIRWAY FALLS
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-2606
Mailing Address - Country:US
Mailing Address - Phone:302-454-7928
Mailing Address - Fax:302-454-7928
Practice Address - Street 1:314 EAST MAIN STREET
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19711
Practice Address - Country:US
Practice Address - Phone:305-369-3533
Practice Address - Fax:302-369-3093
Is Sole Proprietor?:No
Enumeration Date:2009-10-14
Last Update Date:2009-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC50000126363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant