Provider Demographics
NPI:1407049117
Name:SCHAFFER, RICHARD S JR (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:S
Last Name:SCHAFFER
Suffix:JR
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 1:309 S SHARON AMITY RD STE 302
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-2976
Mailing Address - Country:US
Mailing Address - Phone:704-360-3057
Mailing Address - Fax:
Practice Address - Street 1:309 S SHARON AMITY RD STE 302
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-2976
Practice Address - Country:US
Practice Address - Phone:704-360-3057
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-26
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC26568207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCG88034Medicare UPIN