Provider Demographics
NPI:1033507108
Name:MCDONALD, ROBERT KEITH
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:KEITH
Last Name:MCDONALD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2539 SAMIRA RD
Mailing Address - Street 2:
Mailing Address - City:STOW
Mailing Address - State:OH
Mailing Address - Zip Code:44224-3525
Mailing Address - Country:US
Mailing Address - Phone:330-329-5367
Mailing Address - Fax:
Practice Address - Street 1:2539 SAMIRA RD
Practice Address - Street 2:
Practice Address - City:STOW
Practice Address - State:OH
Practice Address - Zip Code:44224-3525
Practice Address - Country:US
Practice Address - Phone:330-329-5367
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-24
Last Update Date:2014-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN368017163W00000X, 163WC0200X, 163WE0003X, 163WH1000X, 163WM0705X, 163WW0000X, 163WX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX0200XNursing Service ProvidersRegistered NurseOncology
No163W00000XNursing Service ProvidersRegistered Nurse
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
No163WE0003XNursing Service ProvidersRegistered NurseEmergency
No163WH1000XNursing Service ProvidersRegistered NurseHospice
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
No163WW0000XNursing Service ProvidersRegistered NurseWound Care