Provider Demographics
NPI:1053378489
Name:SCHURMAN, ELLEN MARIE (MD)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:MARIE
Last Name:SCHURMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ELLEN
Other - Middle Name:M
Other - Last Name:PISTERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3448 STATE ROUTE 31
Mailing Address - Street 2:
Mailing Address - City:BALDWINSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13027-9231
Mailing Address - Country:US
Mailing Address - Phone:315-622-6595
Mailing Address - Fax:315-622-3298
Practice Address - Street 1:3448 STATE ROUTE 31
Practice Address - Street 2:
Practice Address - City:BALDWINSVILLE
Practice Address - State:NY
Practice Address - Zip Code:13027-9231
Practice Address - Country:US
Practice Address - Phone:315-622-6595
Practice Address - Fax:315-622-3298
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY222730208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02187768Medicaid
G77108Medicare UPIN
NY02187768Medicaid