Provider Demographics
NPI:1154439974
Name:SCHMIDT, MARIA ELAINE (MD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:ELAINE
Last Name:SCHMIDT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 S CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:HARTSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10530-2319
Mailing Address - Country:US
Mailing Address - Phone:914-761-4030
Mailing Address - Fax:914-949-2931
Practice Address - Street 1:141 S CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:HARTSDALE
Practice Address - State:NY
Practice Address - Zip Code:10530-2319
Practice Address - Country:US
Practice Address - Phone:914-761-4030
Practice Address - Fax:914-949-2931
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2014-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2577202085R0202X
TXM0559174400000X, 2085R0202X
CAG887492085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G887490OtherBLUE SHIELD
TX172229002Medicaid
TX172229003Medicaid
CA1154439974Medicaid
TX172229002Medicaid
TX172229003Medicaid
CAED429ZMedicare PIN
TXP00404248Medicare PIN
TX8J3240Medicare PIN