Provider Demographics
NPI:1306069075
Name:DONALDSON, PAUL STREINER (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:STREINER
Last Name:DONALDSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6225 FRANK AVE NW
Mailing Address - Street 2:
Mailing Address - City:NORTH CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720-8439
Mailing Address - Country:US
Mailing Address - Phone:330-497-6555
Mailing Address - Fax:330-497-3281
Practice Address - Street 1:6225 FRANK AVE NW
Practice Address - Street 2:
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720-8439
Practice Address - Country:US
Practice Address - Phone:330-497-6555
Practice Address - Fax:330-497-3281
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2009-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT4211207Q00000X
OH35-039492207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT12563Medicaid
MTC64115Medicare UPIN
MT12563Medicaid