Provider Demographics
NPI:1831462357
Name:POHORENCE, DONALD J (PA-C)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:J
Last Name:POHORENCE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7255 OLD OAK BLVD
Mailing Address - Street 2:STE C208
Mailing Address - City:MIDDLEBURG HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44130-3300
Mailing Address - Country:US
Mailing Address - Phone:440-816-2708
Mailing Address - Fax:440-243-8480
Practice Address - Street 1:2940 N MCCORD RD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-1753
Practice Address - Country:US
Practice Address - Phone:419-842-3000
Practice Address - Fax:419-842-3042
Is Sole Proprietor?:No
Enumeration Date:2012-02-14
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.003479363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH079890Medicare PIN
MIMI1635036Medicare PIN