MEDICARE: ROBERT C SCHNACKENBERG MD

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
1	2084P0804X	Child & Adolescent Psychiatry Physician	5816	SC
2	2084P0800X	Psychiatry Physician	5816	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548240484
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT C SCHNACKENBERG MD

Provider Business Mailing Address
First Line	:	1415 BLANDING ST
Second Line	:	SUITE 4
City	:	COLUMBIA
State	:	SC
Zip	:	29201-2922
Country	:	US
Telephone Number	:	803-779-7500
Fax Number	:	803-779-7522

Provider Business Practice Location Address
First Line	:	1415 BLANDING ST
Second Line	:	SUITE 4
City	:	COLUMBIA
State	:	SC
Zip	:	29201-2922
Country	:	US
Telephone Number	:	803-779-7500
Fax Number	:	803-779-7522

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/18/2006
Last Update Date	:	07/24/2015

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