Healthcare Provider Details

I. General information

NPI: 1497983712
Provider Name (Legal Business Name): JOHN WILHELM SCHROEDER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2009
Last Update Date: 07/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10800 KNIGHTS RD
PHILADELPHIA PA
19114-4200
US

IV. Provider business mailing address

2500 MARYLAND RD STE 504
WILLOW GROVE PA
19090-1226
US

V. Phone/Fax

Practice location:
  • Phone: 215-612-4000
  • Fax:
Mailing address:
  • Phone: 215-481-6836
  • Fax: 215-481-5788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberOS015981
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: