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NPI Code Detail

MEDICARE: DR. MARK RICHARD SCHRODER PSY. D.

MEDICARE: DR. MARK RICHARD SCHRODER PSY. D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical Psychologist4776OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1000000020680OTHEROHANTHEM
207 239 039OTHEROHPCN

General Provider Information

NPI Number : 1154489417
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARK RICHARD SCHRODER PSY. D.
Provider Business Mailing Address
First Line : 2810 MACK ROAD
Second Line :
City : FAIRFIELD
State : OH
Zip : 45014-5130
Country : US
Telephone Number : 513-874-4530
Fax Number : 513-346-3811
Provider Business Practice Location Address
First Line : 2810 MACK ROAD
Second Line :
City : FAIRFIELD
State : OH
Zip : 45014-5130
Country : US
Telephone Number : 513-874-4530
Fax Number : 513-346-3811
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/05/2006
Last Update Date : 05/06/2008

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