Provider Demographics
NPI:1063419414
Name:SHOENTHAL, HENRY (MD)
Entity type:Individual
Prefix:
First Name:HENRY
Middle Name:
Last Name:SHOENTHAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1086 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15905-4305
Mailing Address - Country:US
Mailing Address - Phone:814-410-8300
Mailing Address - Fax:814-410-8331
Practice Address - Street 1:4186 CORTLAND DR
Practice Address - Street 2:
Practice Address - City:NEW PARIS
Practice Address - State:PA
Practice Address - Zip Code:15554-7706
Practice Address - Country:US
Practice Address - Phone:814-839-4108
Practice Address - Fax:814-839-4845
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD014343E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
B36742Medicare UPIN
PASH108431Medicare ID - Type Unspecified