Provider Demographics
NPI:1770719114
Name:JEFFREY C. SCHMIDLEIN, MD
Entity type:Organization
Organization Name:JEFFREY C. SCHMIDLEIN, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:K
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-647-4025
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:21146-4127
Mailing Address - Country:US
Mailing Address - Phone:410-647-8829
Mailing Address - Fax:410-315-8444
Practice Address - Street 1:844 RITCHIE HWY
Practice Address - Street 2:SUITE 206
Practice Address - City:SEVERNA PARK
Practice Address - State:MD
Practice Address - Zip Code:21146-4127
Practice Address - Country:US
Practice Address - Phone:410-647-8829
Practice Address - Fax:410-315-8444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-29
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD30741207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD486781500Medicaid
MDD73852Medicare UPIN