Provider Demographics
NPI:1508845926
Name:SCHANER, SUSAN (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:SCHANER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 POST OFFICE RD
Mailing Address - Street 2:SUITE M
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20602-2744
Mailing Address - Country:US
Mailing Address - Phone:301-932-5838
Mailing Address - Fax:301-843-0324
Practice Address - Street 1:7 POST OFFICE RD
Practice Address - Street 2:SUITE M
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-2744
Practice Address - Country:US
Practice Address - Phone:301-932-5838
Practice Address - Fax:301-843-0324
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-13
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0024395207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD2136101OtherMAMSI/ALLIANCE
MD010014004OtherRAILROAD MEDICARE
MD42045202OtherBLUE CROSS OF MARYLAND
MD7427Medicare ID - Type Unspecified
MD010014004OtherRAILROAD MEDICARE