Healthcare Provider Details

I. General information

NPI: 1194716936
Provider Name (Legal Business Name): KAREN RUSSELL SCHMIDT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2005
Last Update Date: 07/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 MOYE BLVD ECU PHYSICIANS PEDIATRIC GENETICS
GREENVILLE NC
27834-4300
US

IV. Provider business mailing address

PO BOX 751069
CHARLOTTE NC
28275-1069
US

V. Phone/Fax

Practice location:
  • Phone: 252-744-2335
  • Fax: 252-744-3811
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License Number200100089
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: