Basic Information
| Provider Information | |||||||||
| NPI: | 1518049022 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SCHREIBER | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | ROBERT | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | CONNECTICUT CHILDREN'S SPECIALTY GROUP | ||||||||
| Address2: | 282 WASHINGTON SRT. | ||||||||
| City: | HARTFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 061063322 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8605459000 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 282 WASHINGTON ST | ||||||||
| Address2: | |||||||||
| City: | HARTFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 061063322 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8605459000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/20/2006 | ||||||||
| LastUpdateDate: | 04/14/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/14/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 48988 | MA | N | Allopathic & Osteopathic Physicians | Pediatrics | 2080P0208X | 67425 | WI | N | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Infectious Diseases | 2080P0208X | 48988 | MA | N | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Infectious Diseases | 2080P0208X | 64058 | CT | Y | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Infectious Diseases |
ID Information
| ID | Type | State | Issuer | Description | 2213941 | 01 | MN | ARAZ | OTHER | 604R0SC | 01 | MN | BLUE CROSS BLUE SHIELD | OTHER | 0079832 | 05 | MT | MEDICAID | 132251 | 01 | MN | UCARE | OTHER | 547407800 | 05 | MN | MEDICAID | 92-12094 | 01 | MN | MEDICA PRIMARY | OTHER | 0079822 | 05 | MT | MEDICAID | 9200168 | 01 | MN | MEDICA CHOICE | OTHER | 34565100 | 05 | WI | MEDICAID | HP45306 | 01 | MN | HEALTH PARTNERS | OTHER | 0597468 | 05 | IA | MEDICAID | 1518049022 | 05 | WI | MEDICAID | 1042021 | 01 | MN | PREFERRED ONE | OTHER |