Provider Demographics
NPI:1326126376
Name:SCHMIDT, SCOTT GARY (DC)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:GARY
Last Name:SCHMIDT
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1387 BELL LN
Mailing Address - Street 2:
Mailing Address - City:MAPLE GLEN
Mailing Address - State:PA
Mailing Address - Zip Code:19002-3222
Mailing Address - Country:US
Mailing Address - Phone:215-518-4218
Mailing Address - Fax:
Practice Address - Street 1:1701 BETHLEHEM PIKE
Practice Address - Street 2:
Practice Address - City:FLOURTOWN
Practice Address - State:PA
Practice Address - Zip Code:19031-1112
Practice Address - Country:US
Practice Address - Phone:215-233-2276
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC002860L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA11026419OtherCAQH
PAP938718OtherOXFORD
PA0048418000OtherKEYSTONE
PA083391OtherBLUE SHIELD
PA2176800OtherAETNA HMO
PA083391OtherPIN
PA4349742OtherAETNA
PA1053037OtherASH
PA083391OtherBLUE SHIELD
PA083391S9AMedicare ID - Type Unspecified