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General NPI Number Information
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NPI Number | 1245536853
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Entity Type | Organization
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Legal Business Name | MARK SCHROEDER MD, LLC
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Dates
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Enumeration Date | 01/28/2011
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Last Update Date | 05/21/2014
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Provider Practice Location Address
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Address Line | 354 WARRENVILLE RD
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City | MANSFIELD CENTER
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State | CT
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Zip | 06250-1130
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Country | US
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Telephone | 860-455-9879
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Fax |
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Provider Business Mailing Address
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Address Line | 354 WARRENVILLE RD
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City | MANSFIELD CENTER
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State | CT
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Zip | 06250-1130
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Country | US
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Telephone | 860-455-9879
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARK SCHROEDER
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Credential | M.D.
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Telephone | 960-455-9879
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TP0016X
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Taxonomy Name | Prescribing (Medical) Psychologist
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License Number | 028905
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License Number State | CT
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