Provider Demographics
NPI:1124116629
Name:SCHNEIDER, STEPHEN SCOTT (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:SCOTT
Last Name:SCHNEIDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:208 SAN MARINO DR
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-1582
Mailing Address - Country:US
Mailing Address - Phone:415-453-8164
Mailing Address - Fax:
Practice Address - Street 1:735 MONTGOMERY ST
Practice Address - Street 2:SUITE 300
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94111-2108
Practice Address - Country:US
Practice Address - Phone:415-776-7227
Practice Address - Fax:415-474-0393
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2009-12-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG241132084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA42164Medicare UPIN
CA00G241130Medicare ID - Type Unspecified