Provider Demographics
NPI:1568428241
Name:SCHADE, MARK EDWARD (PT)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:EDWARD
Last Name:SCHADE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4623 RIPLEY MANOR TERR
Mailing Address - Street 2:
Mailing Address - City:OLNEY
Mailing Address - State:MD
Mailing Address - Zip Code:20832
Mailing Address - Country:US
Mailing Address - Phone:301-570-6867
Mailing Address - Fax:
Practice Address - Street 1:17902 GEORGIA AVE
Practice Address - Street 2:STE 100
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832-2272
Practice Address - Country:US
Practice Address - Phone:301-260-8383
Practice Address - Fax:301-260-8894
Is Sole Proprietor?:No
Enumeration Date:2006-04-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC2871225100000X
MD194452251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Not Answered2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1277557OtherAETNA HMO
MD5415680OtherAETNA PPO