Provider Demographics
NPI:1073693289
Name:SCHNEIDERMAN, SCOTT HOWARD (DO)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:HOWARD
Last Name:SCHNEIDERMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:835 CASS ST
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-2904
Mailing Address - Country:US
Mailing Address - Phone:831-649-5456
Mailing Address - Fax:831-649-0550
Practice Address - Street 1:835 CASS ST
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-2904
Practice Address - Country:US
Practice Address - Phone:831-649-5456
Practice Address - Fax:831-649-0550
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2010-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A5388207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX53880Medicaid
CA020A53880Medicare ID - Type Unspecified
CAE07294Medicare UPIN