Basic Information
Provider Information | |||||||||
NPI: | 1124028212 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | SCHMIDT | ||||||||
FirstName: | DIANE | ||||||||
MiddleName: | NORLAINE | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1021 PARK AVE STE 20 | ||||||||
Address2: |   | ||||||||
City: | QUAKERTOWN | ||||||||
State: | PA | ||||||||
PostalCode: | 189510130 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4845267300 | ||||||||
FaxNumber: | 6107913107 | ||||||||
Practice Location | |||||||||
Address1: | 1021 PARK AVE STE 20 | ||||||||
Address2: |   | ||||||||
City: | QUAKERTOWN | ||||||||
State: | PA | ||||||||
PostalCode: | 189510130 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4845267300 | ||||||||
FaxNumber: | 6107913107 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/29/2005 | ||||||||
LastUpdateDate: | 01/24/2018 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RE0101X | MD-065127-L | PA | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism |
ID Information
ID | Type | State | Issuer | Description | 0016979550002 | 05 | PA |   | MEDICAID | 0562533000 | 01 | PA | KEYSTONE EAST | OTHER | 2950659 | 01 | PA | AETNA | OTHER |