Provider Demographics
NPI:1982693800
Name:SCHAFER, JYME HOLLY (MD)
Entity Type:Individual
Prefix:DR
First Name:JYME
Middle Name:HOLLY
Last Name:SCHAFER
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 1:9B W RIDGELY RD
Mailing Address - Street 2:PMB 110
Mailing Address - City:TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21093-5113
Mailing Address - Country:US
Mailing Address - Phone:410-786-4643
Mailing Address - Fax:
Practice Address - Street 1:9B W RIDGELY RD
Practice Address - Street 2:PMB 110
Practice Address - City:TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093-5113
Practice Address - Country:US
Practice Address - Phone:410-786-4643
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK3983207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK3983Medicaid
AKE12233Medicare UPIN
AK150603Medicare ID - Type Unspecified