Provider Demographics
NPI:1194866087
Name:SCHAEFFER, MARK ALLEN (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:ALLEN
Last Name:SCHAEFFER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 BUNN DR
Mailing Address - Street 2:SUITE 302
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-1968
Mailing Address - Country:US
Mailing Address - Phone:609-921-1680
Mailing Address - Fax:609-921-1438
Practice Address - Street 1:800 BUNN DR
Practice Address - Street 2:SUITE 302
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-1968
Practice Address - Country:US
Practice Address - Phone:609-921-1680
Practice Address - Fax:609-921-1438
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2012-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04680500207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ271656004OtherTAX ID # PRINCETON PREMIER MEDICINE, LLC
NJ223457805OtherTAX ID NUMBER
NJ271656004OtherTAX ID # PRINCETON PREMIER MEDICINE, LLC
NJ223457805OtherTAX ID NUMBER