Provider Demographics
NPI:1891772984
Name:SCHLUEDERBERG, CARL JEFFREY (MD)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:JEFFREY
Last Name:SCHLUEDERBERG
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 1:9114 PHILADELPHIA RD
Mailing Address - Street 2:SUITE 106 - 108
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21237-4345
Mailing Address - Country:US
Mailing Address - Phone:410-918-0777
Mailing Address - Fax:410-369-1707
Practice Address - Street 1:9114 PHILADELPHIA RD
Practice Address - Street 2:SUITE 106 - 108
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21237-4345
Practice Address - Country:US
Practice Address - Phone:410-918-0777
Practice Address - Fax:410-369-1707
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0036951207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
4140404OtherAETNA PPO
100095OtherAETNA HMO
883889OtherMANSI
W6560001OtherBLUE CHOICE
883889OtherMANSI
196M251FMedicare ID - Type Unspecified