Provider Demographics
NPI:1962474023
Name:SCHMIDLEIN, JEFFREY CLARK (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:CLARK
Last Name:SCHMIDLEIN
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 1:844 RITCHIE HWY
Mailing Address - Street 2:SUITE 206
Mailing Address - City:SEVERNA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21146
Mailing Address - Country:US
Mailing Address - Phone:410-647-8300
Mailing Address - Fax:410-315-8444
Practice Address - Street 1:844 RITCHIE HWY
Practice Address - Street 2:STE 206
Practice Address - City:SEVERNA PARK
Practice Address - State:MD
Practice Address - Zip Code:21146-4137
Practice Address - Country:US
Practice Address - Phone:410-647-8300
Practice Address - Fax:410-315-8444
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-03
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD30741207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
110236249OtherMCRR
522166976OtherTAX ID #
7495JCOtherMC
06246OtherAMERICAID
522166976OtherALL OTHER INS.
0553696119OtherUHC HMO
06731OtherPHN
25990OtherPRIORITY
866083OtherMD/OP/ALLIANCE
MD486781500Medicaid
T1980001OtherBSFED
T1980001OtherBLUE CHOICE
2161151OtherUS AETNA (HMO)
486781500OtherMA
11129OtherBS POS
1S18OtherBS
25990OtherEHP
4324896OtherAETNA
D73852Medicare UPIN
MD7495JCMedicare ID - Type Unspecified