Healthcare Provider Details

I. General information

NPI: 1013222793
Provider Name (Legal Business Name): ROBERTA J SCHNELLER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2010
Last Update Date: 10/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3350 WILKENS AVE SUITE 101
BALTIMORE MD
21229-4600
US

IV. Provider business mailing address

3350 WILKENS AVE SUITE 101
BALTIMORE MD
21229-4600
US

V. Phone/Fax

Practice location:
  • Phone: 410-644-8500
  • Fax: 410-644-8900
Mailing address:
  • Phone: 410-644-8500
  • Fax: 410-644-8900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberC0004008
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: