Provider Demographics
NPI:1760469837
Name:SCHMIDT, MARK D (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:D
Last Name:SCHMIDT
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 1:8780 RED LION FIVE POINTS RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45066-9606
Mailing Address - Country:US
Mailing Address - Phone:937-951-0998
Mailing Address - Fax:937-567-0076
Practice Address - Street 1:8780 RED LION 5 POINTS RD
Practice Address - Street 2:
Practice Address - City:SPRINGBORO
Practice Address - State:OH
Practice Address - Zip Code:45066-9606
Practice Address - Country:US
Practice Address - Phone:937-321-4958
Practice Address - Fax:937-866-8494
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-29
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35054254S207Q00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH647858Medicaid
OHSC0626202Medicare PIN
OH647858Medicaid