=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841494564
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CAROL L SCHMIDT MD LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/14/2007
-----------------------------------------------------
Last Update Date | 08/30/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1377 CHEWS LANDING RD
-----------------------------------------------------
City | LAUREL SPRINGS
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08021
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-227-3434
-----------------------------------------------------
Fax | 856-227-6001
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2 YORKSHIRE DR
-----------------------------------------------------
City | VOORHEES
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08043-3730
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-772-3436
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER PHYSICIAN
-----------------------------------------------------
Name | DR. CAROL L SCHMIDT
-----------------------------------------------------
Credential | M D
-----------------------------------------------------
Telephone | 856-722-3436
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | MA05079700
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------