Basic Information
| Provider Information | |||||||||
| NPI: | 1699826891 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SCHAFER | ||||||||
| FirstName: | CHARLES | ||||||||
| MiddleName: | H | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 13579 | ||||||||
| Address2: | |||||||||
| City: | READING | ||||||||
| State: | PA | ||||||||
| PostalCode: | 196123579 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4846281324 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2701 HOLME AVE | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191522029 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2153318897 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/15/2007 | ||||||||
| LastUpdateDate: | 09/03/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | MD032621E | PA | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 0084019000 | 01 | PA | INDEPENDENCE BLUE CROSS | OTHER | 0147817 | 01 | PA | BLUE SHIELD | OTHER | 00108992530005 | 05 | PA | MEDICAID |