1730492141 NPI number — DR. REBECCA A SCHUSTER D.O.

Table of content: DR. REBECCA A SCHUSTER D.O. (NPI 1730492141)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730492141 NPI number — DR. REBECCA A SCHUSTER D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHUSTER
Provider First Name:
REBECCA
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1730492141
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/10/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3580 PEACH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ERIE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16508-2776
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-864-9994
Provider Business Mailing Address Fax Number:
814-864-1909

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
310 W UNION ST STE 102
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ATHENS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45701-2312
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-589-3044
Provider Business Practice Location Address Fax Number:
740-589-3045
Provider Enumeration Date:
07/15/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207YS0123X , with the licence number:  34.011833 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207YS0123X , with the licence number: OT013794 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0136282 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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