Provider Demographics
NPI:1255424248
Name:KLINESTIVER, DONALD G (MD)
Entity type:Individual
Prefix:MR
First Name:DONALD
Middle Name:G
Last Name:KLINESTIVER
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 1:1028 MASON ST
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:WV
Mailing Address - Zip Code:25541
Mailing Address - Country:US
Mailing Address - Phone:304-743-4244
Mailing Address - Fax:304-743-3124
Practice Address - Street 1:1028 MASON ST
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:WV
Practice Address - Zip Code:25541
Practice Address - Country:US
Practice Address - Phone:304-743-4244
Practice Address - Fax:304-743-3124
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV08955207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0049588000Medicaid
011029207OtherMEDICARE TRAVELERS
000149730OtherBCBS
WV0176761Medicare ID - Type Unspecified
011029207OtherMEDICARE TRAVELERS