Provider Demographics
NPI:1598077885
Name:DONICH NEUROSURGERY AND SPINE, LLC
Entity Type:Organization
Organization Name:DONICH NEUROSURGERY AND SPINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANE
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:DONICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-576-3500
Mailing Address - Street 1:PO BOX 26125
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44319-6125
Mailing Address - Country:US
Mailing Address - Phone:888-719-9015
Mailing Address - Fax:330-493-7123
Practice Address - Street 1:3562 RIDGE PARK DR
Practice Address - Street 2:SUITE A
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-9294
Practice Address - Country:US
Practice Address - Phone:330-576-3500
Practice Address - Fax:330-576-3900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-02
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3073329Medicaid
OH6410880001Medicare NSC
OH9389721Medicare PIN