Provider Demographics
NPI:1629049028
Name:SCHMIDT, RICHARD G (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:G
Last Name:SCHMIDT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 PRESIDENTIAL BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-1006
Mailing Address - Country:US
Mailing Address - Phone:610-667-2663
Mailing Address - Fax:610-667-4235
Practice Address - Street 1:15 PRESIDENTIAL BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-1006
Practice Address - Country:US
Practice Address - Phone:610-667-2663
Practice Address - Fax:610-667-4235
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-01
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD026765E207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA094447Medicare PIN
PAC29714Medicare UPIN