Provider Demographics
NPI:1861476061
Name:RIDDLE, DONALD MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:MICHAEL
Last Name:RIDDLE
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 2429
Mailing Address - Street 2:
Mailing Address - City:KINSTON
Mailing Address - State:NC
Mailing Address - Zip Code:28502-2429
Mailing Address - Country:US
Mailing Address - Phone:252-522-0335
Mailing Address - Fax:252-522-4016
Practice Address - Street 1:2509 N QUEEN ST
Practice Address - Street 2:
Practice Address - City:KINSTON
Practice Address - State:NC
Practice Address - Zip Code:28501-1632
Practice Address - Country:US
Practice Address - Phone:252-522-0335
Practice Address - Fax:252-522-4016
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC28891208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8971685Medicaid
NC71685OtherBCBS
NC8971685Medicaid