Provider Demographics
NPI:1649266727
Name:SCHAAL, JENNIFER C (MD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:C
Last Name:SCHAAL
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 1:802 GREEN VALLEY RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-7041
Mailing Address - Country:US
Mailing Address - Phone:336-370-0277
Mailing Address - Fax:336-333-9757
Practice Address - Street 1:802 GREEN VALLEY RD
Practice Address - Street 2:SUITE 200
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-7041
Practice Address - Country:US
Practice Address - Phone:336-370-0277
Practice Address - Fax:336-333-9757
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC30123174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC49002OtherMEDCOST
NC1159OtherPARTNERS HMO
NC353113OtherONE HEALTH
NC74776OtherBCBS
NC890166BMedicaid
NC0700817OtherUNITED HEALTH CARE
NCC86322Medicare UPIN
NC353113OtherONE HEALTH