Provider Demographics
NPI:1760481469
Name:DAVID, KERRIE LYNN (DO)
Entity Type:Individual
Prefix:DR
First Name:KERRIE
Middle Name:LYNN
Last Name:DAVID
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2458 LINCOLN WAY E
Mailing Address - Street 2:
Mailing Address - City:MASSILLON
Mailing Address - State:OH
Mailing Address - Zip Code:44646-5085
Mailing Address - Country:US
Mailing Address - Phone:330-837-1111
Mailing Address - Fax:330-832-1341
Practice Address - Street 1:2458 LINCOLN WAY E
Practice Address - Street 2:
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44646-5085
Practice Address - Country:US
Practice Address - Phone:330-837-1111
Practice Address - Fax:330-832-1341
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34006511207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2165062Medicaid
OHH01475Medicare UPIN
OHDA0887761Medicare ID - Type Unspecified