Provider Demographics
NPI:1821094418
Name:SCHANZER, MARY CATHLEEN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:CATHLEEN
Last Name:SCHANZER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 GUTHRIE SQ
Mailing Address - Street 2:
Mailing Address - City:SAYRE
Mailing Address - State:PA
Mailing Address - Zip Code:18840-1625
Mailing Address - Country:US
Mailing Address - Phone:800-474-4482
Mailing Address - Fax:570-887-3236
Practice Address - Street 1:1 GUTHRIE SQ
Practice Address - Street 2:
Practice Address - City:SAYRE
Practice Address - State:PA
Practice Address - Zip Code:18840-1625
Practice Address - Country:US
Practice Address - Phone:800-474-4482
Practice Address - Fax:901-683-8401
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000020254207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3049420Medicaid
TN4007524OtherBC
B88018Medicare UPIN
MS180000248Medicare PIN
TN3049420Medicaid
MS180000248Medicare ID - Type Unspecified
TN3049422Medicare PIN