1043242233 NPI number — DR. CRYSTAN M SCHNEIDER MD

Table of content: DR. CRYSTAN M SCHNEIDER MD (NPI 1043242233)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043242233 NPI number — DR. CRYSTAN M SCHNEIDER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHNEIDER
Provider First Name:
CRYSTAN
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043242233
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/18/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
400 WESTHAMPTON STA
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RICHMOND
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23226-3330
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-287-4200
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 WESTHAMPTON STA
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RICHMOND
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23226-3330
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-443-6180
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  0101244778 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207W00000X , with the licence number: D0062965 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2137362 . This is a "MAMSI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 521692515 . This is a "UNITED HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: A5650006 . This is a "NCA FEDERAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 64670701 . This is a "CAREFIRST BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2137362 . This is a "MDIPA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2137362 . This is a "OPTIMUM CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 07694717 . This is a "AETNA PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2137362 . This is a "ALLIANCE PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9411626 . This is a "PHCS" identifier . This identifiers is of the category "OTHER".




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