Provider Demographics
NPI:1639150709
Name:SCHNEIDER, HARRIS DAVID (MD)
Entity Type:Individual
Prefix:
First Name:HARRIS
Middle Name:DAVID
Last Name:SCHNEIDER
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 1:6142 ANNAPURNA DR
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN
Mailing Address - State:CO
Mailing Address - Zip Code:80439-5314
Mailing Address - Country:US
Mailing Address - Phone:510-918-4877
Mailing Address - Fax:510-918-4877
Practice Address - Street 1:13855 E 14TH ST
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94578-2611
Practice Address - Country:US
Practice Address - Phone:510-918-4877
Practice Address - Fax:510-918-4877
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2744207P00000X
NY320496207P00000X
CAG25305207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G253050Medicaid
CA00G253050OtherBLUE SHEILD
CA00G253050Medicaid
CA00G253050Medicare PIN
CA00G253050OtherBLUE SHEILD