Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 04-28382 | KS |
Y | 2080P0210X | Pediatric Nephrologist | 27635 | NC |
NPI | 1770693913 |
---|---|
Provider Name | Jonathan I Scheinman |
First Address | Winston Salem, NC 27102-0344 |
Second Address | Winston Salem, NC 27157-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 10/02/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100359320A | (05) | KS |
204814305 | (05) | MO |
25912018 | MISSOURI MEDICAID (01) | MO |
340017342 | RR MEDICARE (01) | |
667390 | FIRSTGUARD (01) | |
C86325 | (02) |