Provider Demographics
NPI:1588624597
Name:SCHOON, DAVID L (MD)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:L
Last Name:SCHOON
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 1:57 LAFAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360-3407
Mailing Address - Country:US
Mailing Address - Phone:860-886-2481
Mailing Address - Fax:860-886-9518
Practice Address - Street 1:57 LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-3407
Practice Address - Country:US
Practice Address - Phone:860-886-2481
Practice Address - Fax:860-886-9518
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2013-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0225692080A0000X
CT22569208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001225697Medicaid
CT001225697Medicaid