Provider Demographics
NPI:1518924778
Name:SCHUCKER, JODI L (MD)
Entity Type:Individual
Prefix:DR
First Name:JODI
Middle Name:L
Last Name:SCHUCKER
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 1:701 OSTRUM ST
Mailing Address - Street 2:SUITE 303
Mailing Address - City:FOUNTAIN HILL
Mailing Address - State:PA
Mailing Address - Zip Code:18015-1155
Mailing Address - Country:US
Mailing Address - Phone:610-954-3900
Mailing Address - Fax:610-954-3908
Practice Address - Street 1:701 OSTRUM ST
Practice Address - Street 2:SUITE 303
Practice Address - City:FOUNTAIN HILL
Practice Address - State:PA
Practice Address - Zip Code:18015-1155
Practice Address - Country:US
Practice Address - Phone:610-954-3900
Practice Address - Fax:610-954-3908
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD050489L207V00000X, 207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0001654386Medicaid
G11304Medicare UPIN
PA0001654386Medicaid