Provider Demographics
NPI:1457312530
Name:SCHROEDER, PHILIP JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:JOHN
Last Name:SCHROEDER
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 1:600 MEMORIAL AVE
Mailing Address - Street 2:STE 402
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502
Mailing Address - Country:US
Mailing Address - Phone:301-724-7666
Mailing Address - Fax:701-724-1318
Practice Address - Street 1:600 MEMORIAL AVE
Practice Address - Street 2:STE 402
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502
Practice Address - Country:US
Practice Address - Phone:301-724-7666
Practice Address - Fax:701-724-1318
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-29
Last Update Date:2009-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0017456208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD769641800Medicaid
D74438Medicare UPIN
7501PJMedicare ID - Type Unspecified