Basic Information
| Provider Information | |||||||||
| NPI: | 1487910022 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SCHOTT | ||||||||
| FirstName: | KYLE | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2027 PULASKI HIGHWAY | ||||||||
| Address2: | #205 | ||||||||
| City: | HAVRE DE GRACE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210782147 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4438436363 | ||||||||
| FaxNumber: | 4438436653 | ||||||||
| Practice Location | |||||||||
| Address1: | 2027 PULASKI HIGHWAY | ||||||||
| Address2: | #205 | ||||||||
| City: | HAVRE DE GRACE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210782147 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4438436363 | ||||||||
| FaxNumber: | 4438436653 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/09/2012 | ||||||||
| LastUpdateDate: | 04/10/2012 | ||||||||
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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 | 363AS0400X | C0004707 | MD | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
No ID Information.