Provider Demographics
NPI:1841377199
Name:SCHIOWITZ, MARK FUERTH (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:FUERTH
Last Name:SCHIOWITZ
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 1:545 N RIVER ST
Mailing Address - Street 2:SUITE 20
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18702-2600
Mailing Address - Country:US
Mailing Address - Phone:570-823-3089
Mailing Address - Fax:570-822-0795
Practice Address - Street 1:545 N RIVER ST
Practice Address - Street 2:SUITE 20
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18702-2600
Practice Address - Country:US
Practice Address - Phone:570-823-3089
Practice Address - Fax:570-822-0795
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD023346E208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA072117OtherFIRST PRIORITY HEALTH
PAP005802OtherCHAMPUS/TRICARE
PA34350OtherHEALTH AMERICA
PASC1626399OtherHIGHMARK BLUE SHIELD
PA4075451OtherAETNA
PA0009130620002Medicaid
PA80580OtherUNISON
PAP005802OtherCHAMPUS/TRICARE
PASC181352Medicare PIN