Provider Demographics
NPI:1568532091
Name:SCHUMAN, CAROLYN ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:ANN
Last Name:SCHUMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CAROLYN
Other - Middle Name:ANN
Other - Last Name:SCHUMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2380 ELLSWORTH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94704-1569
Mailing Address - Country:US
Mailing Address - Phone:510-406-4874
Mailing Address - Fax:510-665-4760
Practice Address - Street 1:2380 ELLSWORTH ST
Practice Address - Street 2:SUITE A
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704-1569
Practice Address - Country:US
Practice Address - Phone:510-406-4874
Practice Address - Fax:510-665-4760
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG40376207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G403760Medicaid
CA00G403760Medicaid
CA00G403760Medicare ID - Type Unspecified