Healthcare Provider Details

I. General information

NPI: 1831160860
Provider Name (Legal Business Name): DAPHNE ELEANOR SCHNEIDER M. D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2006
Last Update Date: 12/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

236 HIGHLAND AVE 2ND FLOOR
SOMERVILLE MA
02143-1495
US

IV. Provider business mailing address

1493 CAMBRIDGE ST
CAMBRIDGE MA
02139-1047
US

V. Phone/Fax

Practice location:
  • Phone: 617-591-6300
  • Fax: 617-591-4340
Mailing address:
  • Phone: 617-665-3100
  • Fax: 617-665-3180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number232027
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number36-107087
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number246074
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: