Provider Demographics
NPI:1952362402
Name:DOHANISH, RONALD STEVEN (PAC)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:STEVEN
Last Name:DOHANISH
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:501 WEST 14TH ST
Mailing Address - Street 2:6TH FL
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19801
Mailing Address - Country:US
Mailing Address - Phone:302-428-6600
Mailing Address - Fax:302-428-6750
Practice Address - Street 1:4735 OGLETOWN STANTON RD
Practice Address - Street 2:STE 2210
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713
Practice Address - Country:US
Practice Address - Phone:302-623-4144
Practice Address - Fax:302-623-4147
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DEC50000507363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
018199P52Medicare ID - Type Unspecified
Q22902Medicare UPIN