Provider Demographics
NPI:1912970443
Name:MILLER-SCHAEFFER, CAROL ANN (MD)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:ANN
Last Name:MILLER-SCHAEFFER
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:PO BOX 783311
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-3311
Mailing Address - Country:US
Mailing Address - Phone:484-884-4500
Mailing Address - Fax:
Practice Address - Street 1:106 S CLAUDE A LORD BLVD
Practice Address - Street 2:
Practice Address - City:POTTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17901
Practice Address - Country:US
Practice Address - Phone:570-622-4209
Practice Address - Fax:570-622-1386
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD042053L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0473231OtherUS HEALTHCARE
PA0998130OtherKEYSTONE SPECIALIST
PA0000675657OtherBLUE SHIELD
PA01143401OtherCAPITAL BLUE CROSS
PA110118250OtherRAILROAD MEDICARE PBA
PA0012465150002Medicaid
PA01143401OtherKEYSTONE
PA116993900OtherFEDERAL EMPLOYEES COMP
PA203010OtherFEDERAL BLACK LUNG
PA7095OtherGEISINGER HEALTH PLAN
PA0012465150002Medicaid
E89201Medicare UPIN