1366416513 NPI number — CHARLES RICHARD SCHOTT MD

Table of content: CHARLES RICHARD SCHOTT MD (NPI 1366416513)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366416513 NPI number — CHARLES RICHARD SCHOTT MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHOTT
Provider First Name:
CHARLES
Provider Middle Name:
RICHARD
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1366416513
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/23/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
207 N BROAD ST
Provider Second Line Business Mailing Address:
3RD FLR.
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19107-1500
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
267-479-4142
Provider Business Mailing Address Fax Number:
215-463-3820

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1088 W BALTIMORE PIKE STE 2400
Provider Second Line Business Practice Location Address:
FL 4
Provider Business Practice Location Address City Name:
MEDIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19063
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-565-2100
Provider Business Practice Location Address Fax Number:
610-892-0626
Provider Enumeration Date:
02/15/2006

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: 207RC0000X , with the licence number:  MD012673E , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000639106 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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