Provider Demographics
NPI:1154320828
Name:WAYNE, DONALD L (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:L
Last Name:WAYNE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 636256
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-6256
Mailing Address - Country:US
Mailing Address - Phone:513-245-3600
Mailing Address - Fax:513-245-3672
Practice Address - Street 1:3590 LUCILLE DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45213-2674
Practice Address - Country:US
Practice Address - Phone:513-475-8521
Practice Address - Fax:513-458-1982
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2017-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.051493207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0706258Medicaid
KY64016454Medicaid
IN100024550Medicaid
A17512Medicare UPIN
IN100024550Medicaid