Provider Demographics
NPI:1649253071
Name:SCHIFFER, FREDRIC (MD)
Entity type:Individual
Prefix:DR
First Name:FREDRIC
Middle Name:
Last Name:SCHIFFER
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 1:72 SHERIDAN RD
Mailing Address - Street 2:
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02481-5450
Mailing Address - Country:US
Mailing Address - Phone:781-237-9620
Mailing Address - Fax:
Practice Address - Street 1:30 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:NEWTON HIGHLANDS
Practice Address - State:MA
Practice Address - Zip Code:02461-1527
Practice Address - Country:US
Practice Address - Phone:617-969-1188
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA361982084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAA66125Medicare UPIN
MAMO8576Medicare ID - Type Unspecified