Provider Demographics
NPI:1952336414
Name:BIETER SCHULTZ, DEBORAH (DO)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:BIETER SCHULTZ
Suffix:
Gender:F
Credentials:DO
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 1109
Mailing Address - Street 2:450 CRESSON BLVD SUITE 300
Mailing Address - City:OAKS
Mailing Address - State:PA
Mailing Address - Zip Code:19456-1109
Mailing Address - Country:US
Mailing Address - Phone:610-482-4778
Mailing Address - Fax:610-666-3310
Practice Address - Street 1:495 THOMAS JONES WAY
Practice Address - Street 2:BAXTER BLDG 2 SUITE 210
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341-2553
Practice Address - Country:US
Practice Address - Phone:610-280-3636
Practice Address - Fax:610-280-1569
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2014-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06665600207V00000X
PAOS005632L207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7653701Medicaid
NJ3319674OtherAETNA ID NUMBER
NJ3K4525OtherHEALTHNET ID NUMBER
NJ10651933OtherCAQH NUMBER
NJ3319674OtherAETNA ID NUMBER
NJ10651933OtherCAQH NUMBER