Provider Demographics
NPI:1598751687
Name:SCHWARZENBERG, MICHAEL R (MD)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:R
Last Name:SCHWARZENBERG
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 1:110 N PRICE ST
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:WV
Mailing Address - Zip Code:26537-1120
Mailing Address - Country:US
Mailing Address - Phone:304-329-3500
Mailing Address - Fax:304-329-2088
Practice Address - Street 1:110 N PRICE ST
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:WV
Practice Address - Zip Code:26537-1120
Practice Address - Country:US
Practice Address - Phone:304-329-3500
Practice Address - Fax:304-329-2088
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV14978207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVWV14978OtherHEALTH PLAN
WV001710244OtherBCBS GROUP
WV0051964000Medicaid
WV001721175OtherBCBS
WV001721175OtherBCBS
WVWV14978OtherHEALTH PLAN