Provider Demographics
NPI:1013222793
Name:SCHNELLER, ROBERTA J (PA-C)
Entity Type:Individual
Prefix:
First Name:ROBERTA
Middle Name:J
Last Name:SCHNELLER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3350 WILKENS AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21229-4600
Mailing Address - Country:US
Mailing Address - Phone:410-644-8500
Mailing Address - Fax:410-644-8900
Practice Address - Street 1:3350 WILKENS AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21229-4600
Practice Address - Country:US
Practice Address - Phone:410-644-8500
Practice Address - Fax:410-644-8900
Is Sole Proprietor?:No
Enumeration Date:2010-08-18
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0004008363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical