NPIMap

Individual provider Active NPI

Zachary Ryan Dottor, PA-C

  • Physician Assistant
  • Wilke Barre, PA
National Provider Identifier
1619749082
Registry record updated Apr 4, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
MA064884 Issued in PA
Practice address
1000 East Mountain Blvd
Wilke Barre, PA 18711-0027
Phone
(570) 808-7861
Fax
(570) 808-1069
NPI assigned
Oct 27, 2023
Last updated
Apr 4, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 4, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X MA064884 PA Primary
Surgical Physician Assistant 363AS0400X MA064884 PA
Surgical Physician Assistant 363AS0400X OA006668 PA

Addresses

Primary practice location

1000 East Mountain Blvd
Wilke Barre, PA 18711-0027

Mailing address

100 N Academy Ave
Danville, PA 17822-4903
Phone (570) 808-7861

Other practice location 1

601 Park St # 1445
Honesdale, PA 18431-1498
Phone (570) 253-8100

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240815004503 PA Practitioner - Physician Assistant 6305384777 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Geisinger ClinicGroup PAC ID 5395657001, 3,432 clinicians

Practice addresses (Care Compare)

100 N Academy Ave
Danville, PA 17822-9800
Phone (570) 271-6144

1000 E Mountain Dr
Wilkes Barre, PA 18711-0027
Phone (570) 826-7300

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
MA064884PAMDPhysician Assistant
OA006668PAMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Geisinger Clinic Physician Assistant CurrentSince Apr 21, 2025 Accepting new patients
Wayne Memorial Hospital CurrentSince Jun 9, 2024 Accepting new patients
Geisinger Clinic CurrentSince Apr 21, 2025 Accepting new patients
Wayne Memorial Hospital CurrentSince Jun 9, 2024 Accepting new patients

Locations

100 N Academy Ave
Danville, PA 17822

601 Park St
Honesdale, PA 18431
Phone (570) 253-8100

601 Park St
#1445
Honesdale, PA 18431
Phone (570) 253-8100

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 20

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 20

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1698364800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1743724800000",
    "number": "1619749082",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 N ACADEMY AVE",
            "city": "DANVILLE",
            "state": "PA",
            "postal_code": "178224903",
            "telephone_number": "570-808-7861",
            "fax_number": "570-808-1069"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 EAST MOUNTAIN BLVD",
            "city": "WILKE BARRE",
            "state": "PA",
            "postal_code": "187110027",
            "telephone_number": "570-808-7861",
            "fax_number": "570-808-1069"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "601 Park St # 1445",
            "address_purpose": "LOCATION",
            "city": "Honesdale",
            "state": "PA",
            "postal_code": "184311498",
            "country_code": "US",
            "telephone_number": "570-253-8100",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DOTTOR",
        "first_name": "ZACHARY",
        "middle_name": "RYAN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-10-27",
        "last_updated": "2025-04-04",
        "certification_date": "2025-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": "MA064884",
            "primary": true
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "PA",
            "license": "MA064884",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "PA",
            "license": "OA006668",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Sources for this page

Verify at the official NPI Registry.