Provider Demographics
NPI:1669490991
Name:SCHNEIDER, BARRY RANDALL (MD)
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:RANDALL
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 1:11301 CARMEL COMMONS BLVD
Mailing Address - Street 2:STE 302
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-5305
Mailing Address - Country:US
Mailing Address - Phone:704-372-7974
Mailing Address - Fax:704-372-8201
Practice Address - Street 1:11301 CARMEL COMMONS BLVD
Practice Address - Street 2:STE 302
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-5305
Practice Address - Country:US
Practice Address - Phone:704-372-7974
Practice Address - Fax:704-372-8201
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC31198207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8974903Medicaid
NC204095CMedicare ID - Type Unspecified
NCC82287Medicare UPIN