MEDICARE: DR RUSSELL O SCHUB PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner
2	207RG0100X	Gastroenterology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	8338RU	OTHER	MD	BLUE SHIELD
3	C428	OTHER	DC	BLUE SHIELD

General Provider Information

NPI Number	:	1336332998
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR RUSSELL O SCHUB PA

Provider Business Mailing Address
First Line	:	8875 CENTRE PARK DR
Second Line	:	SUITE D
City	:	COLUMBIA
State	:	MD
Zip	:	21045-2382
Country	:	US
Telephone Number	:	410-730-1000
Fax Number	:	410-730-8615

Provider Business Practice Location Address
First Line	:	8875 CENTRE PARK DR
Second Line	:	SUITE D
City	:	COLUMBIA
State	:	MD
Zip	:	21045-2382
Country	:	US
Telephone Number	:	410-730-1000
Fax Number	:	410-730-8615

Authorized Official
Title or Position	:	PRESIDENT
Name	:	RUSSELL O. SCHUB
Credential	:	D.O.
Telephone Number	:	410-730-1000

Provider Enumeration Date	:	08/27/2007
Last Update Date	:	01/08/2009

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