Provider Demographics
NPI:1881621472
Name:SCHAEFFER, MARTIN (MD)
Entity type:Individual
Prefix:
First Name:MARTIN
Middle Name:
Last Name:SCHAEFFER
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 1:7449 MORGAN RD
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13090-3901
Mailing Address - Country:US
Mailing Address - Phone:315-451-5400
Mailing Address - Fax:315-451-5422
Practice Address - Street 1:7449 MORGAN RD
Practice Address - Street 2:
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13090-3901
Practice Address - Country:US
Practice Address - Phone:315-451-5400
Practice Address - Fax:315-451-5422
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO43930208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO69409056Medicaid
CO803530Medicare ID - Type Unspecified
CO69409056Medicaid