Provider Demographics
NPI:1659391662
Name:KINLEY, DONALD (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:
Last Name:KINLEY
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 656
Mailing Address - Street 2:
Mailing Address - City:BRATTLEBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05302-0656
Mailing Address - Country:US
Mailing Address - Phone:802-254-9441
Mailing Address - Fax:802-254-3233
Practice Address - Street 1:EXIT ONE PARK
Practice Address - Street 2:71 GSP DRIVE
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05302
Practice Address - Country:US
Practice Address - Phone:802-254-9441
Practice Address - Fax:802-254-3233
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0420004737207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT00004974OtherBC VT
VT18P003OtherMVP
VT0004974Medicaid
NH00000492Medicaid
VT0004974Medicaid
B85569Medicare UPIN