Provider Demographics
NPI:1992715106
Name:SCHNEIDER, EDWARD (PA)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:SCHNEIDER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:332 140 VILLAGE RD
Mailing Address - Street 2:# 167
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-6196
Mailing Address - Country:US
Mailing Address - Phone:410-876-9785
Mailing Address - Fax:410-386-0783
Practice Address - Street 1:686 POOLE RD # C
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-6003
Practice Address - Country:US
Practice Address - Phone:410-848-2444
Practice Address - Fax:410-857-1634
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0002808363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDI651Medicare ID - Type Unspecified