Basic Information
| Provider Information | |||||||||
| NPI: | 1023065455 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SCHNEEWEIS | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 630 PLANTATION ST | ||||||||
| Address2: | |||||||||
| City: | WORCESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 01605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9784663208 | ||||||||
| FaxNumber: | 9788401680 | ||||||||
| Practice Location | |||||||||
| Address1: | 165 MILL ST | ||||||||
| Address2: | |||||||||
| City: | LEOMINSTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 01453 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9784663208 | ||||||||
| FaxNumber: | 9788401680 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/30/2006 | ||||||||
| LastUpdateDate: | 02/25/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 58233 | MA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 042472266 | 01 | HEALTHCARE VALUE MANAGMEN | OTHER | 26998 | 01 | HEALTHY START | OTHER | AA1224 | 01 | HARVARD PILGRIM HEALTHCAR | OTHER | 042472266 | 01 | ONE HEALTH PLAN | OTHER | 26998 | 01 | CHILDRENS MEDICAL SECURIT | OTHER | 5884434 | 01 | AETNA US HEALTHCARE | OTHER | 784185 | 01 | MVP HEALTH CARE | OTHER | J08904 | 01 | BLUE CARE ELECT | OTHER | J08904 | 01 | BLUE SHIELD INDEMNITY | OTHER | 0100294 | 01 | EVERCARE | OTHER | 3521498 | 01 | CIGNA HEALTH PLAN | OTHER | J08904 | 01 | MEDICARE B | OTHER | 3103820 | 05 | MA | MEDICAID | 9900287 | 01 | FALLON COMMUNITY HEALTH P | OTHER | J08904 | 01 | BLUE SHIELD HMO BLUE | OTHER | 3103820 | 01 | MEDICAID WELFARE | OTHER | 042472266 | 01 | PRIVATE HEALTHCARE SYSTEM | OTHER | 1150309 | 01 | FIRST HEALTH | OTHER |