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NPI Code Detail

MEDICARE: DR. DONALD ALBERT DESHETLER JR. MD

MEDICARE: DR. DONALD ALBERT DESHETLER JR. MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician35076727DOH

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2080148293OTHEROHRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1073510558
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DONALD ALBERT DESHETLER JR. MD
Provider Business Mailing Address
First Line : 2000 NEWARK GRANVILLE RD
Second Line : SUITE 100
City : GRANVILLE
State : OH
Zip : 43023-9135
Country : US
Telephone Number : 740-587-0087
Fax Number : 740-587-0084
Provider Business Practice Location Address
First Line : 2000 NEWARK GRANVILLE RD
Second Line : SUITE 100
City : GRANVILLE
State : OH
Zip : 43023-9135
Country : US
Telephone Number : 740-587-0087
Fax Number : 740-587-0084
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/30/2005
Last Update Date : 02/24/2016

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