Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | DC001659L | PA |
NPI | 1235125477 |
---|---|
Provider Name | Dr. Donald Jerome Maher |
First Address | Ronks, PA 17572-9700 |
Second Address | Ronks, PA 17572-9700 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2005 |
Last Update Date | 15/08/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00634567 | (05) | PA |
T28776 | (02) | PA |