Provider Demographics
NPI:1780686675
Name:SCHOLLER, BEVERLY (MD)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:
Last Name:SCHOLLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25950 DIXIE HWY STE 400
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-2983
Mailing Address - Country:US
Mailing Address - Phone:567-585-0010
Mailing Address - Fax:567-225-3490
Practice Address - Street 1:25950 DIXIE HWY STE 400
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-2983
Practice Address - Country:US
Practice Address - Phone:567-585-0010
Practice Address - Fax:567-225-3490
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35056704208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0634067OtherAETNA
OH12-01205OtherUHC
OH370012703OtherRRMC
OH000000141231OtherANTHEM
OH00306OtherPARAMOUNT
OH0729975Medicaid
OH370012703OtherRRMC