Provider Demographics
NPI:1669463220
Name:SCHROER, RICHARD J (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:J
Last Name:SCHROER
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 1:101 GREGOR MENDEL CIR
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29646-2316
Mailing Address - Country:US
Mailing Address - Phone:864-941-8100
Mailing Address - Fax:864-941-8114
Practice Address - Street 1:3520 W MONTAGUE AVE STE 104
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29418-6083
Practice Address - Country:US
Practice Address - Phone:843-746-1001
Practice Address - Fax:843-746-1002
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9091207SG0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC090911Medicaid
SCD17672Medicare UPIN