Provider Demographics
NPI:1841349685
Name:SUSAN K JONAS MD
Entity type:Organization
Organization Name:SUSAN K JONAS MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:JONAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-454-0362
Mailing Address - Street 1:J 30 OMEGA DR
Mailing Address - Street 2:OMEGA PROFESSIONAL CENTER
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713
Mailing Address - Country:US
Mailing Address - Phone:302-454-0362
Mailing Address - Fax:302-456-9424
Practice Address - Street 1:J 30 OMEGA DR
Practice Address - Street 2:OMEGA PROFESSIONAL CENTER
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713
Practice Address - Country:US
Practice Address - Phone:302-454-0362
Practice Address - Fax:302-456-9424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10002323207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000081102Medicaid
DEDO1191Medicare UPIN
DE439983Medicare ID - Type Unspecified