Provider Demographics
NPI:1942362793
Name:SCHENCK, JOHN BENNETT (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:BENNETT
Last Name:SCHENCK
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 1:204 PARSONS RD
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29483-3348
Mailing Address - Country:US
Mailing Address - Phone:854-201-3636
Mailing Address - Fax:
Practice Address - Street 1:204 PARSONS RD
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29483-3348
Practice Address - Country:US
Practice Address - Phone:854-201-3636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22409207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC224091Medicaid
NC5900709Medicaid
NC2040318Medicare ID - Type Unspecified
NC5900709Medicaid
NCI30711Medicare UPIN
SC224091Medicaid