Provider Demographics
NPI:1396716122
Name:SCHIMMER, BARRY MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:BARRY
Middle Name:MICHAEL
Last Name:SCHIMMER
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 1:822 PINE ST
Mailing Address - Street 2:SUITE 3A
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-6187
Mailing Address - Country:US
Mailing Address - Phone:215-829-5358
Mailing Address - Fax:215-923-6442
Practice Address - Street 1:822 PINE ST
Practice Address - Street 2:SUITE 3A
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-6187
Practice Address - Country:US
Practice Address - Phone:215-829-5358
Practice Address - Fax:215-923-6442
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD012979E207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0626082Medicaid
PA162172Medicare ID - Type Unspecified
PA0626082Medicaid