Provider Demographics
NPI:1194751198
Name:SCHAEFER, PAUL S (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:S
Last Name:SCHAEFER
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 1:4110 ASPEN HILL RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20853-2853
Mailing Address - Country:US
Mailing Address - Phone:301-438-5150
Mailing Address - Fax:301-460-0199
Practice Address - Street 1:67 THOMAS JOHNSON DR
Practice Address - Street 2:SUITE 4
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4863
Practice Address - Country:US
Practice Address - Phone:301-607-0444
Practice Address - Fax:301-831-4495
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2013-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00292652085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD058541600Medicaid
VA007238185Medicaid
VA007238193Medicaid
VA010075327Medicaid
VA010072506Medicaid
DC010871200Medicaid
VA007235038Medicaid
VA007238207Medicaid
VA010075297Medicaid
VA010075343Medicaid
VA010075114Medicaid
VA010075343Medicaid
VA007238185Medicaid
161834K90Medicare ID - Type UnspecifiedKORSOWER & PION
161834C10Medicare ID - Type UnspecifiedCOMMUNITY RADIOLOGY
DC010871200Medicaid
300048419Medicare PIN
VA010075327Medicaid
MD058541600Medicaid