Provider Demographics
NPI:1831160860
Name:SCHNEIDER, DAPHNE ELEANOR (M D)
Entity type:Individual
Prefix:DR
First Name:DAPHNE
Middle Name:ELEANOR
Last Name:SCHNEIDER
Suffix:
Gender:F
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1493 CAMBRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-1047
Mailing Address - Country:US
Mailing Address - Phone:617-665-3100
Mailing Address - Fax:617-665-3180
Practice Address - Street 1:236 HIGHLAND AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02143-1495
Practice Address - Country:US
Practice Address - Phone:617-591-6300
Practice Address - Fax:617-591-4340
Is Sole Proprietor?:No
Enumeration Date:2006-01-28
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY232027207QG0300X
IL36-107087207QG0300X
MA246074207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110087433/AMedicaid
MA001937001Medicare PIN
ILI06081Medicare UPIN