Provider Demographics
NPI:1073510558
Name:DESHETLER, DONALD ALBERT JR (MD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:ALBERT
Last Name:DESHETLER
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:2000 NEWARK GRANVILLE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GRANVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43023-9135
Mailing Address - Country:US
Mailing Address - Phone:740-587-0087
Mailing Address - Fax:740-587-0084
Practice Address - Street 1:2000 NEWARK GRANVILLE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:GRANVILLE
Practice Address - State:OH
Practice Address - Zip Code:43023-9135
Practice Address - Country:US
Practice Address - Phone:740-587-0087
Practice Address - Fax:740-587-0084
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2016-02-24
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Provider Licenses
StateLicense IDTaxonomies
OH35076727D207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2130956Medicaid
OH080148293OtherRAILROAD MEDICARE
OHDE0887591Medicare PIN
OH080148293OtherRAILROAD MEDICARE