Provider Demographics
NPI:1467552570
Name:SCHOWENGERDT, CARL GORDON (MD)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:GORDON
Last Name:SCHOWENGERDT
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 1:716 ADAIR AVE
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-2836
Mailing Address - Country:US
Mailing Address - Phone:740-454-5239
Mailing Address - Fax:740-455-7693
Practice Address - Street 1:716 ADAIR AVE
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-2836
Practice Address - Country:US
Practice Address - Phone:740-454-5239
Practice Address - Fax:740-455-7693
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.025730208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0223887Medicaid
OH000000349823OtherANTHEM
OH0223887Medicaid
OH000000349823OtherANTHEM
OHSC0546213Medicare ID - Type Unspecified