Provider Demographics
NPI:1023065455
Name:SCHNEEWEIS, JOHN R (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:R
Last Name:SCHNEEWEIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 PLANTATION ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605
Mailing Address - Country:US
Mailing Address - Phone:978-466-3208
Mailing Address - Fax:978-840-1680
Practice Address - Street 1:165 MILL ST
Practice Address - Street 2:
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453
Practice Address - Country:US
Practice Address - Phone:978-466-3208
Practice Address - Fax:978-840-1680
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA58233207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
042472266OtherHEALTHCARE VALUE MANAGMEN
26998OtherHEALTHY START
AA1224OtherHARVARD PILGRIM HEALTHCAR
042472266OtherONE HEALTH PLAN
26998OtherCHILDRENS MEDICAL SECURIT
5884434OtherAETNA US HEALTHCARE
784185OtherMVP HEALTH CARE
J08904OtherBLUE CARE ELECT
J08904OtherBLUE SHIELD INDEMNITY
0100294OtherEVERCARE
3521498OtherCIGNA HEALTH PLAN
J08904OtherMEDICARE B
MA3103820Medicaid
9900287OtherFALLON COMMUNITY HEALTH P
J08904OtherBLUE SHIELD HMO BLUE
3103820OtherMEDICAID WELFARE
042472266OtherPRIVATE HEALTHCARE SYSTEM
1150309OtherFIRST HEALTH
J08904OtherBLUE SHIELD HMO BLUE
MAJ08904Medicare ID - Type Unspecified