Healthcare Provider Details

I. General information

NPI: 1740710631
Provider Name (Legal Business Name): ROBERT ANTHONY SCHNIETZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2017
Last Update Date: 07/15/2024
Certification Date: 11/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MEDICAL PARK DR STE 460
CONCORD NC
28025-2982
US

IV. Provider business mailing address

PO BOX 19305
CHARLOTTE NC
28219-9305
US

V. Phone/Fax

Practice location:
  • Phone: 704-403-2777
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number2023-02604
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: