Provider Demographics
NPI:1952746901
Name:ROEDER, DONALD KISTLER (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:KISTLER
Last Name:ROEDER
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 1:16 MEADOWOOD PL
Mailing Address - Street 2:
Mailing Address - City:BOILING SPRINGS
Mailing Address - State:PA
Mailing Address - Zip Code:17007-9449
Mailing Address - Country:US
Mailing Address - Phone:717-243-9023
Mailing Address - Fax:
Practice Address - Street 1:16 MEADOWOOD PL
Practice Address - Street 2:
Practice Address - City:BOILING SPRINGS
Practice Address - State:PA
Practice Address - Zip Code:17007-9449
Practice Address - Country:US
Practice Address - Phone:717-243-9023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-03
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD028258L208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice