Provider Demographics
NPI:1215968615
Name:SCHNEIDER, JUDITH RUTH (PA C)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:RUTH
Last Name:SCHNEIDER
Suffix:
Gender:F
Credentials:PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1780
Mailing Address - Street 2:DIMENSIONS HEALTH CORPORATION
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20717-1780
Mailing Address - Country:US
Mailing Address - Phone:800-777-2455
Mailing Address - Fax:610-617-6280
Practice Address - Street 1:15001 HEALTH CENTER DR
Practice Address - Street 2:BOWIE HEALTH CENTER
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20716-1017
Practice Address - Country:US
Practice Address - Phone:301-262-6150
Practice Address - Fax:610-617-6280
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0000847363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
S11583Medicare UPIN
MD008177Medicare ID - Type Unspecified