Healthcare Provider Details

I. General information

NPI: 1770693913
Provider Name (Legal Business Name): JONATHAN I SCHEINMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 02/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MEDICAL CENTER BLVD
WINSTON SALEM NC
27157-0001
US

IV. Provider business mailing address

PO BOX 344
WINSTON SALEM NC
27102-0344
US

V. Phone/Fax

Practice location:
  • Phone: 336-716-2255
  • Fax: 336-716-9229
Mailing address:
  • Phone: 336-716-2255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number04-28382
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License Number27635
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier204814305
Identifier TypeMEDICAID
Identifier StateMO
Identifier Issuer
# 2
Identifier667390
Identifier TypeOTHER
Identifier State
Identifier IssuerFIRSTGUARD
# 3
Identifier100359320A
Identifier TypeMEDICAID
Identifier StateKS
Identifier Issuer
# 4
Identifier25912018
Identifier TypeOTHER
Identifier StateMO
Identifier IssuerMISSOURI MEDICAID
# 5
Identifier340017342
Identifier TypeOTHER
Identifier State
Identifier IssuerRR MEDICARE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: