MEDICARE: MARK ALLAN SCHIMELMAN M.D.

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	208D00000X	General Practice Physician	149089	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	149089	OTHER	NY	LICENSE

General Provider Information

NPI Number	:	1649276122
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK ALLAN SCHIMELMAN M.D.

Provider Business Mailing Address
First Line	:	76 N GREENBUSH RD
Second Line	:
City	:	TROY
State	:	NY
Zip	:	12180-8369
Country	:	US
Telephone Number	:	518-286-3000
Fax Number	:	518-286-3008

Provider Business Practice Location Address
First Line	:	76 N GREENBUSH RD
Second Line	:
City	:	TROY
State	:	NY
Zip	:	12180-8369
Country	:	US
Telephone Number	:	518-286-3000
Fax Number	:	518-286-3008

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/21/2005
Last Update Date	:	07/08/2007

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