Provider Demographics
NPI:1659320703
Name:SCHRAM, ETHAN DALIERE (MD)
Entity type:Individual
Prefix:DR
First Name:ETHAN
Middle Name:DALIERE
Last Name:SCHRAM
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 1:575 LENNON LN STE 153
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-2443
Mailing Address - Country:US
Mailing Address - Phone:925-433-8786
Mailing Address - Fax:925-433-8788
Practice Address - Street 1:575 LENNON LN STE 153
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-2443
Practice Address - Country:US
Practice Address - Phone:925-433-8786
Practice Address - Fax:925-433-8788
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA100608207R00000X, 207RH0003X, 207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology