Provider Demographics
NPI:1548297443
Name:ZELLER, DONALD J (MD)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:J
Last Name:ZELLER
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 1:11 INDUSTRIAL BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:PAOLI
Mailing Address - State:PA
Mailing Address - Zip Code:19301-1632
Mailing Address - Country:US
Mailing Address - Phone:484-527-0410
Mailing Address - Fax:484-527-0415
Practice Address - Street 1:11 INDUSTRIAL BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301-1632
Practice Address - Country:US
Practice Address - Phone:484-527-0410
Practice Address - Fax:484-527-0415
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD031630E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAC87348Medicare UPIN
C87348Medicare UPIN
PA0018846800002Medicaid