Provider Demographics
NPI:1902957186
Name:SCHAEFFER, EDWARD GEORGE (MSPT)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:GEORGE
Last Name:SCHAEFFER
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 88
Mailing Address - Street 2:
Mailing Address - City:MEDFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02052-0088
Mailing Address - Country:US
Mailing Address - Phone:508-376-2100
Mailing Address - Fax:
Practice Address - Street 1:18 PRISCILLA CIR
Practice Address - Street 2:
Practice Address - City:WELLESLEY HILLS
Practice Address - State:MA
Practice Address - Zip Code:02481-5311
Practice Address - Country:US
Practice Address - Phone:508-376-2100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4729174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA37064OtherHPHC PROVIDER NUMBER
MAY66580OtherBCBS PROVIDER NUMBER
MA714390OtherTUFTS PROVIDER NUMBER
MA37064OtherHPHC PROVIDER NUMBER