Provider Demographics
NPI:1053583492
Name:MARC S SCHNEIDER MDPA
Entity type:Organization
Organization Name:MARC S SCHNEIDER MDPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:SCHNEIDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-277-9999
Mailing Address - Street 1:12751 S CLEVELAND AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-7732
Mailing Address - Country:US
Mailing Address - Phone:239-277-9999
Mailing Address - Fax:239-277-3998
Practice Address - Street 1:12751 S CLEVELAND AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-7732
Practice Address - Country:US
Practice Address - Phone:239-277-9999
Practice Address - Fax:239-277-3998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-26
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0050478208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE91544Medicare UPIN
FL12572Medicare PIN