Individual provider Active NPI

Carl Jeffrey Schluederberg, MD

  • Family Medicine Physician
  • Baltimore, MD
National Provider Identifier
1891772984
Registry record updated Feb 17, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
D0036951 Issued in MD
Practice address
9114 Philadelphia Rd
Suite 106 - 108
Baltimore, MD 21237-4345
Phone
(410) 918-0777
Fax
(410) 369-1707
NPI assigned
Dec 29, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 17, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X D0036951 MD Primary

Addresses

Primary practice location

9114 Philadelphia Rd
Suite 106 - 108
Baltimore, MD 21237-4345

Mailing address

9114 Philadelphia Rd
Suite 106 - 108
Baltimore, MD 21237-4345
Phone (410) 918-0777

Other identifiers 4

IdentifierTypeStateIssuer
4140404OtherAETNA PPO
100095OtherAETNA HMO
883889OtherMANSI
W6560001OtherBLUE CHOICE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
D0036951MDMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Medical Health Group, PA Family Medicine Current Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients

Locations

1415 S Mountain Rd
#100
Joppa, MD 21085
Phone (410) 918-0777

9114 Philadelphia Rd
Ste 106
Rosedale, MD 21237
Phone (240) 443-8255

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1135814400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1297900800000",
    "number": "1891772984",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9114 PHILADELPHIA RD",
            "address_2": "SUITE 106 - 108",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212374345",
            "telephone_number": "410-918-0777",
            "fax_number": "410-369-1707"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9114 PHILADELPHIA RD",
            "address_2": "SUITE 106 - 108",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212374345",
            "telephone_number": "410-918-0777",
            "fax_number": "410-369-1707"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SCHLUEDERBERG",
        "first_name": "CARL",
        "middle_name": "JEFFREY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-29",
        "last_updated": "2011-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MD",
            "license": "D0036951",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA PPO",
            "identifier": "4140404",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA HMO",
            "identifier": "100095",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MANSI",
            "identifier": "883889",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CHOICE",
            "identifier": "W6560001",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.