Basic Information
| Provider Information | |||||||||
| NPI: | 1174598080 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SCHNEIDER | ||||||||
| FirstName: | JEFFREY | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9403 KENWOOD RD | ||||||||
| Address2: | SUITE D203 | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452426895 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5136868100 | ||||||||
| FaxNumber: | 5136868109 | ||||||||
| Practice Location | |||||||||
| Address1: | 9403 KENWOOD RD | ||||||||
| Address2: | SUITE D203 | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452426895 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5136868100 | ||||||||
| FaxNumber: | 5136868109 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/22/2006 | ||||||||
| LastUpdateDate: | 07/29/2011 | ||||||||
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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 | 207RG0300X | 35-055350 | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0683541 | 05 | OH | MEDICAID |