Provider Demographics
NPI:1861427718
Name:KESSLER, DAVID R (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:R
Last Name:KESSLER
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 1:100 DAWN LN
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:OH
Mailing Address - Zip Code:45690-9138
Mailing Address - Country:US
Mailing Address - Phone:740-947-2186
Mailing Address - Fax:740-947-6556
Practice Address - Street 1:621 E 5TH ST
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:OH
Practice Address - Zip Code:45690-1505
Practice Address - Country:US
Practice Address - Phone:740-947-8670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2020-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35072728207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
080156043OtherRAILROAD MEDICARE
5538518OtherAETNA
0103980OtherUNITED HEALTHCARE
000000118299OtherANTHEM
OH2029192Medicaid
5538518OtherAETNA
KE7271661Medicare PIN