Provider Demographics
NPI:1962433656
Name:SCHACHTER, LARRY G (MD)
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:G
Last Name:SCHACHTER
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:PO BOX 447
Mailing Address - Street 2:
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-0447
Mailing Address - Country:US
Mailing Address - Phone:814-371-4361
Mailing Address - Fax:814-371-4360
Practice Address - Street 1:145 HOSPITAL AVE
Practice Address - Street 2:SUITE 112
Practice Address - City:DU BOIS
Practice Address - State:PA
Practice Address - Zip Code:15801-1462
Practice Address - Country:US
Practice Address - Phone:814-371-4361
Practice Address - Fax:814-371-4360
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-040451-E208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001114507Medicaid
PA405083Medicare ID - Type Unspecified
PA001114507Medicaid