Provider Demographics
NPI:1598720393
Name:SCHLONEGER, MARK R (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:R
Last Name:SCHLONEGER
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 1:200 ROCKRIDGE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45322-2748
Mailing Address - Country:US
Mailing Address - Phone:937-274-2117
Mailing Address - Fax:937-274-9809
Practice Address - Street 1:200 ROCKRIDGE RD STE 100
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:OH
Practice Address - Zip Code:45322-2748
Practice Address - Country:US
Practice Address - Phone:937-274-2117
Practice Address - Fax:937-274-9809
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35082305S207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2500547Medicaid
OH2500547Medicaid
OH4150735Medicare PIN
OH4150734Medicare PIN
P00290130Medicare PIN
OH4150737Medicare PIN
OH4150738Medicare PIN