Provider Demographics
NPI:1356479646
Name:KISER, DONALD RAYMOND (DO)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:RAYMOND
Last Name:KISER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 PIKE ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-3515
Mailing Address - Country:US
Mailing Address - Phone:740-376-0060
Mailing Address - Fax:740-376-0062
Practice Address - Street 1:1001 PIKE ST
Practice Address - Street 2:SUITE 3
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750-3515
Practice Address - Country:US
Practice Address - Phone:740-376-0060
Practice Address - Fax:740-376-0062
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-006053207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0041820-000Medicaid
OH0898622Medicaid
WV0041820-000Medicaid
E77938Medicare UPIN