Provider Demographics
NPI:1558592659
Name:SCHWABEROW, DOUGLAS L JR
Entity Type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:L
Last Name:SCHWABEROW
Suffix:JR
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 1:304 TERYL DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:OH
Mailing Address - Zip Code:43050-2938
Mailing Address - Country:US
Mailing Address - Phone:740-398-9141
Mailing Address - Fax:
Practice Address - Street 1:304 TERYL DR
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:OH
Practice Address - Zip Code:43050-2938
Practice Address - Country:US
Practice Address - Phone:740-398-9141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-06
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH212-452172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker