Provider Demographics
NPI:1366407371
Name:SCHANBACHER, CARL F (MD)
Entity type:Individual
Prefix:
First Name:CARL
Middle Name:F
Last Name:SCHANBACHER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:340 MAPLE ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:MARLBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01752-3200
Mailing Address - Country:US
Mailing Address - Phone:508-485-7779
Mailing Address - Fax:508-485-7769
Practice Address - Street 1:340 MAPLE ST
Practice Address - Street 2:SUITE 203
Practice Address - City:MARLBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01752-3200
Practice Address - Country:US
Practice Address - Phone:508-485-7779
Practice Address - Fax:508-485-7769
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2013-12-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA204401207N00000X, 207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM21355Medicare PIN
G36528Medicare UPIN