Provider Demographics
NPI:1457499881
Name:ROBERT C. DONLICK, DO, PA
Entity Type:Organization
Organization Name:ROBERT C. DONLICK, DO, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:C
Authorized Official - Last Name:DONLICK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:410-398-3868
Mailing Address - Street 1:PO BOX 1145
Mailing Address - Street 2:210 CLAYTON AVENUE
Mailing Address - City:CLAYTON
Mailing Address - State:DE
Mailing Address - Zip Code:19938-1145
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:210 CLAYTON AVE.
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:410-398-3868
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE2-0000456207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE044079Medicare PIN