Provider Demographics
NPI:1477641884
Name:PSCHESANG, SAMUEL P I
Entity Type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:P
Last Name:PSCHESANG
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 MOUND AVE
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45150-1033
Mailing Address - Country:US
Mailing Address - Phone:513-383-6355
Mailing Address - Fax:513-831-4370
Practice Address - Street 1:103 MOUND AVE
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:OH
Practice Address - Zip Code:45150-1033
Practice Address - Country:US
Practice Address - Phone:513-383-6355
Practice Address - Fax:513-831-4370
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2311126Medicaid
OH2552876Medicaid