Provider Demographics
NPI:1790838712
Name:SCHRAMM, MARC GILBERT (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:GILBERT
Last Name:SCHRAMM
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3970 BROWN PARK DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026-1166
Mailing Address - Country:US
Mailing Address - Phone:614-534-0013
Mailing Address - Fax:614-534-0033
Practice Address - Street 1:3970 BROWN PARK DR
Practice Address - Street 2:SUITE A
Practice Address - City:HILLIARD
Practice Address - State:OH
Practice Address - Zip Code:43026-1166
Practice Address - Country:US
Practice Address - Phone:614-534-0013
Practice Address - Fax:614-534-0033
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-21
Last Update Date:2009-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4575103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
0927420Medicare PIN
SCCP13641Medicare PIN
P00135698Medicare PIN