Provider Demographics
NPI:1902864416
Name:SCHROER, MARK ALLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:ALLEN
Last Name:SCHROER
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 1:17 EAST SIXTH STREET
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:KY
Mailing Address - Zip Code:41071-1803
Mailing Address - Country:US
Mailing Address - Phone:859-431-8285
Mailing Address - Fax:859-431-8286
Practice Address - Street 1:17 EAST SIXTH STREET
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:KY
Practice Address - Zip Code:41071-1803
Practice Address - Country:US
Practice Address - Phone:859-431-8285
Practice Address - Fax:859-431-8286
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-064929207R00000X
KY30674207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY00543001OtherMEDICARE PTAN
IN200449980Medicaid
OH0204559Medicaid
KY64306749Medicaid
F71555Medicare UPIN
KY64306749Medicaid