Healthcare Provider Details

I. General information

NPI: 1306997119
Provider Name (Legal Business Name): DEIRDRE RUTH SCHAEFER DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

159 MARGARET ST SUITE 100
PLATTSBURGH NY
12901-1874
US

IV. Provider business mailing address

159 MARGARET ST SUITE 100
PLATTSBURGH NY
12901-1874
US

V. Phone/Fax

Practice location:
  • Phone: 518-324-2040
  • Fax: 518-324-2040
Mailing address:
  • Phone: 518-324-2040
  • Fax: 518-324-2040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number232818-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: