Provider Demographics
NPI:1649259110
Name:SCHENCK, PAUL HENRY (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:HENRY
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 1:201 E LAUREL BLVD
Mailing Address - Street 2:
Mailing Address - City:POTTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17901-2534
Mailing Address - Country:US
Mailing Address - Phone:610-398-2800
Mailing Address - Fax:610-366-1343
Practice Address - Street 1:5239 HAMILTON BLVD
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18106-9153
Practice Address - Country:US
Practice Address - Phone:610-398-2800
Practice Address - Fax:610-366-1343
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD017334E207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000718863Medicaid
PA45-503-9203OtherTAX ID
PA126703YH3HMedicare PIN
PA45-503-9203OtherTAX ID