Basic Information
| Provider Information | |||||||||
| NPI: | 1508845926 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SCHANER | ||||||||
| FirstName: | SUSAN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7 POST OFFICE RD | ||||||||
| Address2: | SUITE M | ||||||||
| City: | WALDORF | ||||||||
| State: | MD | ||||||||
| PostalCode: | 206022744 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3019325838 | ||||||||
| FaxNumber: | 3018430324 | ||||||||
| Practice Location | |||||||||
| Address1: | 7 POST OFFICE RD | ||||||||
| Address2: | SUITE M | ||||||||
| City: | WALDORF | ||||||||
| State: | MD | ||||||||
| PostalCode: | 206022744 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3019325838 | ||||||||
| FaxNumber: | 3018430324 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/13/2006 | ||||||||
| LastUpdateDate: | 02/17/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | D0024395 | MD | Y | Allopathic & Osteopathic Physicians | Dermatology |
ID Information
| ID | Type | State | Issuer | Description | 2136101 | 01 | MD | MAMSI/ALLIANCE | OTHER | 010014004 | 01 | MD | RAILROAD MEDICARE | OTHER | 42045202 | 01 | MD | BLUE CROSS OF MARYLAND | OTHER |