Healthcare Provider Details

I. General information

NPI: 1790750669
Provider Name (Legal Business Name): DONALD R SCHOWALTER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

356 FREEPORT ST ROOM 205
NEW KENSINGTON PA
15068-6015
US

IV. Provider business mailing address

356 FREEPORT ST ROOM 205
NEW KENSINGTON PA
15068-6015
US

V. Phone/Fax

Practice location:
  • Phone: 724-335-8223
  • Fax:
Mailing address:
  • Phone: 724-335-8223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD019582E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: