Provider Demographics
NPI:1710987094
Name:KAHN, RONALD JAY (DPM)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:JAY
Last Name:KAHN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:642 S QUEEN ST
Mailing Address - Street 2:SUITE #103
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-3506
Mailing Address - Country:US
Mailing Address - Phone:302-674-9255
Mailing Address - Fax:
Practice Address - Street 1:642 S QUEEN ST
Practice Address - Street 2:SUITE #103
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-3506
Practice Address - Country:US
Practice Address - Phone:302-674-9255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEE1-0000084213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE3976320001Medicare NSC