Provider Demographics
NPI:1639118219
Name:SCHAFFER, TED C (MD)
Entity Type:Individual
Prefix:DR
First Name:TED
Middle Name:C
Last Name:SCHAFFER
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 1:619 MOUNT ROYAL BLVD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15223-1225
Mailing Address - Country:US
Mailing Address - Phone:412-487-4422
Mailing Address - Fax:412-487-7838
Practice Address - Street 1:619 MOUNT ROYAL BLVD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15223-1225
Practice Address - Country:US
Practice Address - Phone:412-487-4422
Practice Address - Fax:412-487-7838
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD024025E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA010457OtherHIGHMARK
PA0008457770001Medicaid
PA010457Medicare ID - Type Unspecified
PA0008457770001Medicaid