MEDICARE: JEREMY WACHENSCHWANZ D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	AP2282058A13	OH
2	2085R0202X	Diagnostic Radiology Physician	34.011121	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538420120
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEREMY WACHENSCHWANZ D.O.

Provider Business Mailing Address
First Line	:	3600 FORBES AVENUE
Second Line	:	FORBES TOWER - PLAZA LEVEL SUITE 140
City	:	PITTSBURGH
State	:	PA
Zip	:	15213
Country	:	US
Telephone Number	:	330-363-6267
Fax Number	:	330-363-2485

Provider Business Practice Location Address
First Line	:	3535 OLENTANGY RIVER RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43214-3998
Country	:	US
Telephone Number	:	614-566-5000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2012
Last Update Date	:	09/12/2019

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