Healthcare Provider Details

I. General information

NPI: 1275515694
Provider Name (Legal Business Name): DONALD R CZERNIACH JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2005
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 N ORANGE BLOSSOM TRL STE 210
KISSIMMEE FL
34744-2308
US

IV. Provider business mailing address

2400 N ORANGE BLOSSOM TRL STE 210
KISSIMMEE FL
34744-2308
US

V. Phone/Fax

Practice location:
  • Phone: 407-944-3071
  • Fax: 407-944-3061
Mailing address:
  • Phone: 407-944-3071
  • Fax: 407-944-3061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number209844
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: