Provider Demographics
NPI:1275568974
Name:SCHNEIDER, PHILIP ALAN (MD)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:ALAN
Last Name:SCHNEIDER
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:PO BOX 80468
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44708-0468
Mailing Address - Country:US
Mailing Address - Phone:330-454-2210
Mailing Address - Fax:330-454-9396
Practice Address - Street 1:2600 6TH ST SW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44710-1702
Practice Address - Country:US
Practice Address - Phone:330-363-6201
Practice Address - Fax:330-454-9397
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35 0664012085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0962338Medicaid
OH0962338Medicaid
OH0962338Medicaid