Individual provider Active NPI

Donald L Seidler, MD

  • Family Medicine Physician
  • Charleston, WV
National Provider Identifier
1417945304
Registry record updated Dec 10, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
21998 Issued in WV
Practice address
4602 Maccorkle Ave SE
Charleston, WV 25304-1848
Phone
(304) 925-4777
Fax
(304) 925-4870
NPI assigned
Oct 13, 2005
Last updated
Dec 10, 2014By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 10, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 21998 WV
Family Medicine Physician 207Q00000X 21998 WV Primary

Addresses

Primary practice location

4602 Maccorkle Ave SE
Charleston, WV 25304-1848

Mailing address

415 Morris St
Suite 304
Charleston, WV 25301-1842
Phone (304) 388-7783

Other identifiers 4

IdentifierTypeStateIssuer
P00261725OtherRAILROAD MEDICARE
3810003612MedicaidWV
0010400000MedicaidWV
3810006527MedicaidWV

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20051101000957 WV Practitioner - Family PracticePractitioner - Emergency Medicine 2062439763 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
21998WVMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Charleston Area Medical Center, Inc. CurrentSince Feb 1, 2015 Accepting new patients
Charleston Area Medical Center Inc CurrentSince Feb 1, 2015 Accepting new patients
Salem Emergency Physicians Service, PC Emergency Medicine PastSince Jul 1, 2008 Accepting new patients
Integrated Health Care Providers Past Accepting new patients

Locations

3200 Maccorkle Ave SE
Charleston, WV 25304
Phone (304) 388-2550

415 Morris St
Ste 304
Charleston, WV 25301

415 Morris St
Ste 309
Charleston, WV 25301
Phone (304) 348-3290

4602 Maccorkle Ave SE
Charleston, WV 25304
Phone (304) 205-7535

501 Morris St
Charleston, WV 25301
Phone (304) 348-6293

800 Pennsylvania Ave
Charleston, WV 25302
Phone (304) 388-2550

130 Goff Mountain Rd
Cross Lanes, WV 25313
Phone (304) 388-7055

314 Goff Mountain Rd
Ste 3
Cross Lanes, WV 25313
Phone (304) 388-7070

3703 Teays Valley Rd
Hurricane, WV 25526
Phone (304) 757-2273

12 Kanawha Ter
Saint Albans, WV 25177
Phone (304) 201-1130

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1129161600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1418169600000",
    "number": "1417945304",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "415 MORRIS ST",
            "address_2": "SUITE 304",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "253011842",
            "telephone_number": "304-388-7783",
            "fax_number": "304-388-7788"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4602 MACCORKLE AVE SE",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "253041848",
            "telephone_number": "304-925-4777",
            "fax_number": "304-925-4870"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SEIDLER",
        "first_name": "DONALD",
        "middle_name": "L",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-13",
        "last_updated": "2014-12-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "WV",
            "license": "21998",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WV",
            "license": "21998",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00261725",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810003612",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0010400000",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810006527",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Charleston, WV

Sources for this page

Verify at the official NPI Registry.