Healthcare Provider Details

I. General information

NPI: 1982832184
Provider Name (Legal Business Name): PAUL LOUIS SCHRAEDER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2009
Last Update Date: 06/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

241 S 6TH ST #2010
PHILADELPHIA PA
19106-3727
US

IV. Provider business mailing address

241 S 6TH ST #2010
PHILADELPHIA PA
19106-3727
US

V. Phone/Fax

Practice location:
  • Phone: 215-923-9765
  • Fax: 215-925-2908
Mailing address:
  • Phone: 215-923-9765
  • Fax: 215-925-2908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License NumberMD9504#
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: