Provider Demographics
NPI:1639285380
Name:SCHAEFER, TERESA INGRAM (PHD)
Entity Type:Individual
Prefix:DR
First Name:TERESA
Middle Name:INGRAM
Last Name:SCHAEFER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6602 CHURCH HILL RD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:CHESTERTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21620-2310
Mailing Address - Country:US
Mailing Address - Phone:410-778-5550
Mailing Address - Fax:410-778-0984
Practice Address - Street 1:6602 CHURCH HILL RD
Practice Address - Street 2:SUITE 500
Practice Address - City:CHESTERTOWN
Practice Address - State:MD
Practice Address - Zip Code:21620-2310
Practice Address - Country:US
Practice Address - Phone:410-778-5550
Practice Address - Fax:410-778-0984
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03590103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD38923OtherJOHNS HOPKINS ID#
MD61-56554OtherUBH ID#
MDLT86-605427-02OtherBLUE CROS LOCAL GROUP #
MDT418-0006OtherBLUE CROSS NAT ID#
MD276609OtherMAMSI ID#
MD720407OtherNCPPO ID#
MD7125205OtherAETNA ID#
MD106333OtherAMERICAN PSYCH SYSTEM ID#
MD415764OtherVALUE OPTIONS MIDATLANTIC
MDT418-0006OtherBLUE CROSS NAT ID#