Basic Information
| Provider Information | |||||||||
| NPI: | 1831190230 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SCHAEFER | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 329 S PLEASANT AVE | ||||||||
| Address2: | |||||||||
| City: | SOMERSET | ||||||||
| State: | PA | ||||||||
| PostalCode: | 155012262 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8144453575 | ||||||||
| FaxNumber: | 8144458039 | ||||||||
| Practice Location | |||||||||
| Address1: | 329 S PLEASANT AVE | ||||||||
| Address2: | |||||||||
| City: | SOMERSET | ||||||||
| State: | PA | ||||||||
| PostalCode: | 155012262 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8144453575 | ||||||||
| FaxNumber: | 8144458039 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2005 | ||||||||
| LastUpdateDate: | 02/09/2017 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | 03/22/2006 | ||||||||
| NPIReactivationDate: | 04/11/2006 | ||||||||
| ProviderGenderCode: | M | ||||||||
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| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QG0300X | MD032332E | PA | Y | Allopathic & Osteopathic Physicians | Family Medicine | Geriatric Medicine |
ID Information
| ID | Type | State | Issuer | Description | 080010028 | 01 | PA | RAILRAOD MEDICARE | OTHER | 1014504 | 01 | PA | GATEWAY | OTHER | 13183 | 01 | PA | ELDERHEALTH | OTHER | 482435NMR | 01 | PA | HIGHMARK BC/BS | OTHER | 0014600500006 | 05 | PA | MEDICAID |