Provider Demographics
NPI:1063482610
Name:CYNTHIA N. SCHAEFFER, MD PA
Entity Type:Organization
Organization Name:CYNTHIA N. SCHAEFFER, MD PA
Other - Org Name:PEDIATRIC PLACE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:N
Authorized Official - Last Name:SCHAEFFER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-360-4446
Mailing Address - Street 1:3100 MOUNTAIN RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:PASADENA
Mailing Address - State:MD
Mailing Address - Zip Code:21122-2018
Mailing Address - Country:US
Mailing Address - Phone:410-360-4446
Mailing Address - Fax:410-360-4449
Practice Address - Street 1:3100 MOUNTAIN RD
Practice Address - Street 2:SUITE E
Practice Address - City:PASADENA
Practice Address - State:MD
Practice Address - Zip Code:21122-2018
Practice Address - Country:US
Practice Address - Phone:410-360-4446
Practice Address - Fax:410-439-3541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-25
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD763500100Medicaid