Provider Demographics
NPI:1457331787
Name:SCHAFFER, ROBERT I (MD1)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:I
Last Name:SCHAFFER
Suffix:
Gender:M
Credentials:MD1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8560 BAYBERRY DR NE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44484-1609
Mailing Address - Country:US
Mailing Address - Phone:330-856-5244
Mailing Address - Fax:330-856-4601
Practice Address - Street 1:5000 E MARKET ST
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484-2259
Practice Address - Country:US
Practice Address - Phone:330-856-2212
Practice Address - Fax:330-856-2668
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-20
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35038355207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0288782Medicaid
OHSC0413232Medicare ID - Type Unspecified
OHA75363Medicare UPIN