Provider Demographics
NPI:1811176548
Name:SCHOENBERGER, SCOTT DAVIES (MD)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:DAVIES
Last Name:SCHOENBERGER
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 1:89 SYLVANIA DR
Mailing Address - Street 2:FLOOR 2
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45440-3281
Mailing Address - Country:US
Mailing Address - Phone:937-427-8900
Mailing Address - Fax:
Practice Address - Street 1:89 SYLVANIA DR
Practice Address - Street 2:FLOOR 2
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45440-3281
Practice Address - Country:US
Practice Address - Phone:937-427-8900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-30
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.120897207W00000X
OH35120897207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0089214Medicaid
OHH233710OtherMEDICARE PIN