Provider Demographics
NPI:1275081564
Name:OMANE, JONATHAN (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:OMANE
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1079 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WEST WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02893-3744
Mailing Address - Country:US
Mailing Address - Phone:401-828-2663
Mailing Address - Fax:
Practice Address - Street 1:627 S EDWIN C MOSES BLVD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45417-3461
Practice Address - Country:US
Practice Address - Phone:937-424-1000
Practice Address - Fax:937-424-1002
Is Sole Proprietor?:No
Enumeration Date:2016-09-14
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant