Provider Demographics
NPI:1790715050
Name:SCHRECK, EDWARD WILLIAMS (DO)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:WILLIAMS
Last Name:SCHRECK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:NELSONVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45764-1436
Mailing Address - Country:US
Mailing Address - Phone:740-753-2327
Mailing Address - Fax:740-753-4749
Practice Address - Street 1:1111 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:NELSONVILLE
Practice Address - State:OH
Practice Address - Zip Code:45764-1436
Practice Address - Country:US
Practice Address - Phone:740-753-2327
Practice Address - Fax:740-753-4749
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.002476207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0310514Medicaid
OHA75681Medicare UPIN
OHSC0425745Medicare ID - Type Unspecified