Provider Demographics
NPI:1952306375
Name:SCHOETTLE, REBECCA JOAN (MD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:JOAN
Last Name:SCHOETTLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1735 27TH STREET
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-2657
Mailing Address - Country:US
Mailing Address - Phone:740-353-6500
Mailing Address - Fax:740-354-5389
Practice Address - Street 1:1735 27TH ST
Practice Address - Street 2:SUITE 201
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-2657
Practice Address - Country:US
Practice Address - Phone:740-353-6500
Practice Address - Fax:740-354-5389
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-14
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-04-8393208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65942898Medicaid
OH000000359860OtherANTHEM BLUE CROSS/BLUE S
OH000000359860OtherBLUE CROSS BLUE SHIELD
OH4316548OtherAETNA
OH0599213Medicaid
OH201893650OtherHEALTH NET FEDERAL SERVIC