Provider Demographics
NPI:1225123292
Name:KESSELRING, RICHARD ALLEN (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:ALLEN
Last Name:KESSELRING
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 1:950 S. MAIN STREET
Mailing Address - Street 2:SUITE 8
Mailing Address - City:CELINA
Mailing Address - State:OH
Mailing Address - Zip Code:45822
Mailing Address - Country:US
Mailing Address - Phone:419-586-2226
Mailing Address - Fax:419-584-2223
Practice Address - Street 1:950 S. MAIN STREET
Practice Address - Street 2:SUITE 8
Practice Address - City:CELINA
Practice Address - State:OH
Practice Address - Zip Code:45822
Practice Address - Country:US
Practice Address - Phone:419-586-2226
Practice Address - Fax:419-584-2223
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35067591K207V00000X
MO2002002055207V00000X
VA0101231438207V00000X
KS30275207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0957559Medicaid
OH7324141Medicare ID - Type Unspecified
OH0957559Medicaid