=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235229972
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | N. CAROLYN SCHANEN MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/13/2006
-----------------------------------------------------
Last Update Date | 01/04/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1600 ROCKLAND RD AI DUPONT HOSPITAL FOR CHILDREN
-----------------------------------------------------
City | WILMINGTON
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19803-3607
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-651-4200
-----------------------------------------------------
Fax | 302-651-5033
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 191 PROVIDER ENROLLMENT
-----------------------------------------------------
City | ROCKLAND
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19732-0191
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-651-4000
-----------------------------------------------------
Fax | 302-651-4945
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207SG0201X
-----------------------------------------------------
Taxonomy Name | Clinical Genetics (M.D.) Physician
-----------------------------------------------------
License Number | C10006785
-----------------------------------------------------
License Number State | DE
-----------------------------------------------------