Healthcare Provider Details

I. General information

NPI: 1326034414
Provider Name (Legal Business Name): BERNICE A SCHWARZENBERG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2005
Last Update Date: 11/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 N PRICE ST
KINGWOOD WV
26537-1120
US

IV. Provider business mailing address

110 N PRICE ST
KINGWOOD WV
26537-1120
US

V. Phone/Fax

Practice location:
  • Phone: 304-329-3500
  • Fax: 304-329-2088
Mailing address:
  • Phone: 304-329-3500
  • Fax: 304-329-2088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number14977
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: