1194751198 NPI number — PAUL S SCHAEFER M.D.

Table of content: PAUL S SCHAEFER M.D. (NPI 1194751198)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194751198 NPI number — PAUL S SCHAEFER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHAEFER
Provider First Name:
PAUL
Provider Middle Name:
S
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1194751198
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/20/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4110 ASPEN HILL RD
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
ROCKVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20853-2853
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-438-5150
Provider Business Mailing Address Fax Number:
301-460-0199

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
67 THOMAS JOHNSON DR
Provider Second Line Business Practice Location Address:
SUITE 4
Provider Business Practice Location Address City Name:
FREDERICK
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21702-4863
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-607-0444
Provider Business Practice Location Address Fax Number:
301-831-4495
Provider Enumeration Date:
06/23/2006

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: 2085R0202X , with the licence number:  D0029265 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 058541600 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 007238185 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 007238193 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010075327 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010072506 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010871200 , issued by the state of ( DC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 007235038 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 007238207 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010075297 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010075343 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010075114 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




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