Healthcare Provider Details

I. General information

NPI: 1114906617
Provider Name (Legal Business Name): DOUGLAS ROBERT SCHULTE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2006
Last Update Date: 03/22/2021
Certification Date: 03/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

888 MAIN ST
WAKEFIELD MA
01880-4080
US

IV. Provider business mailing address

888 MAIN ST
WAKEFIELD MA
01880-4080
US

V. Phone/Fax

Practice location:
  • Phone: 781-620-4888
  • Fax: 781-245-2602
Mailing address:
  • Phone: 781-620-4888
  • Fax: 781-245-2602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number284255
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: