Basic Information
| Provider Information | |||||||||
| NPI: | 1790902427 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DR DOUGLAS C SHOENBERGER, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 101 S MAIN ST | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | COOPERSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 180361912 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6102821170 | ||||||||
| FaxNumber: | 6102820256 | ||||||||
| Practice Location | |||||||||
| Address1: | 101 S MAIN ST | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | COOPERSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 180361912 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6102821170 | ||||||||
| FaxNumber: | 6102820256 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2007 | ||||||||
| LastUpdateDate: | 03/25/2013 | ||||||||
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| AuthorizedOfficialLastName: | WUESTHOFF | ||||||||
| AuthorizedOfficialFirstName: | AMBER | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 6102821170 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD044386E | PA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1198777 | 05 | PA | MEDICAID |