Provider Demographics
NPI:1659320703
Name:SCHRAM, ETHAN DALIERE (MD)
Entity Type:Individual
Prefix:DR
First Name:ETHAN
Middle Name:DALIERE
Last Name:SCHRAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10 WOODLAND RD
Mailing Address - Street 2:MARTIN-O'NEIL CANCER CENTER
Mailing Address - City:SAINT HELENA
Mailing Address - State:CA
Mailing Address - Zip Code:94574-9554
Mailing Address - Country:US
Mailing Address - Phone:707-967-5721
Mailing Address - Fax:707-967-5722
Practice Address - Street 1:10 WOODLAND RD
Practice Address - Street 2:MARTIN-O'NEIL CANCER CENTER
Practice Address - City:SAINT HELENA
Practice Address - State:CA
Practice Address - Zip Code:94574-9554
Practice Address - Country:US
Practice Address - Phone:707-967-5721
Practice Address - Fax:707-967-5722
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA100608207RH0003X, 207RX0202X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine