Provider Demographics
NPI:1225010127
Name:SCHNEEBAUM, RONALD J (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:J
Last Name:SCHNEEBAUM
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 1:25 S RIVER RD
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110-6715
Mailing Address - Country:US
Mailing Address - Phone:603-695-2572
Mailing Address - Fax:
Practice Address - Street 1:25 S RIVER RD
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110-6708
Practice Address - Country:US
Practice Address - Phone:603-695-2750
Practice Address - Fax:603-695-2779
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH11519208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH01YP10634NH01OtherANTHEM BC/BS
NH30203973Medicaid
NH30203973Medicaid