Provider Demographics
NPI:1033139829
Name:SCHWARZENBERG & SCHWARZENBERG MDS
Entity Type:Organization
Organization Name:SCHWARZENBERG & SCHWARZENBERG MDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JANA
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:DILLON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-329-3500
Mailing Address - Street 1:110 N PRICE ST
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:WV
Mailing Address - Zip Code:26537-1120
Mailing Address - Country:US
Mailing Address - Phone:304-329-3500
Mailing Address - Fax:304-329-2088
Practice Address - Street 1:110 N PRICE ST
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:WV
Practice Address - Zip Code:26537-1120
Practice Address - Country:US
Practice Address - Phone:304-329-3500
Practice Address - Fax:304-329-2088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV14978207Q00000X
WV14977208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1598751687OtherINDIVIDUAL NPI M. SCHWARZ
WV0051964000Medicaid
WV14978OtherWV LICENSE #
WAA72498Medicare UPIN
WVSC0597673Medicare ID - Type UnspecifiedMICHAEL R. SCHWARZENBERG