Provider Demographics
NPI:1033183983
Name:SHOENBERGER, DOUGLAS CHARLES (MD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:CHARLES
Last Name:SHOENBERGER
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 1:101 S MAIN STREET
Mailing Address - Street 2:SUITE 101
Mailing Address - City:COOPERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18036-2028
Mailing Address - Country:US
Mailing Address - Phone:610-282-1170
Mailing Address - Fax:610-282-0256
Practice Address - Street 1:101 S MAIN STREET
Practice Address - Street 2:SUITE 101
Practice Address - City:COOPERSBURG
Practice Address - State:PA
Practice Address - Zip Code:18036-2028
Practice Address - Country:US
Practice Address - Phone:610-282-1170
Practice Address - Fax:610-282-0256
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-16
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD044386E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAE37885Medicare UPIN