Healthcare Provider Details

I. General information

NPI: 1790764074
Provider Name (Legal Business Name): CAROL SCHMIDT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2006
Last Update Date: 10/20/2020
Certification Date: 10/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1377 CHEWS LANDING RD
LAUREL SPRINGS NJ
08021-2760
US

IV. Provider business mailing address

301 LIPPINCOTT DR STE 410
MARLTON NJ
08053-4197
US

V. Phone/Fax

Practice location:
  • Phone: 856-227-3434
  • Fax: 856-227-6001
Mailing address:
  • Phone: 856-355-0340
  • Fax: 856-355-0330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MA05079700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: