Provider Demographics
NPI:1790750669
Name:SCHOWALTER, DONALD R (MD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:R
Last Name:SCHOWALTER
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 1:356 FREEPORT ST
Mailing Address - Street 2:ROOM 205
Mailing Address - City:NEW KENSINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15068-6015
Mailing Address - Country:US
Mailing Address - Phone:724-335-8223
Mailing Address - Fax:
Practice Address - Street 1:356 FREEPORT ST
Practice Address - Street 2:ROOM 205
Practice Address - City:NEW KENSINGTON
Practice Address - State:PA
Practice Address - Zip Code:15068-6015
Practice Address - Country:US
Practice Address - Phone:724-335-8223
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD019582E174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAB35134Medicare UPIN
PA078173PD9Medicare ID - Type Unspecified