Provider Demographics
NPI:1083670681
Name:SCHNEIDER, ROGER GLENN (MD)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:GLENN
Last Name:SCHNEIDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ULRICH CITY CENTRE
Mailing Address - Street 2:SUITE 7
Mailing Address - City:LOCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14094-5368
Mailing Address - Country:US
Mailing Address - Phone:716-433-1941
Mailing Address - Fax:716-439-1233
Practice Address - Street 1:ULRICH CITY CENTRE
Practice Address - Street 2:SUITE 7
Practice Address - City:LOCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14094-5368
Practice Address - Country:US
Practice Address - Phone:716-433-1941
Practice Address - Fax:716-439-1233
Is Sole Proprietor?:No
Enumeration Date:2006-04-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY148458207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00776072Medicaid