1154421352 NPI number — MYLES J SCHNEIDER D.P.M

Table of content: MYLES J SCHNEIDER D.P.M (NPI 1154421352)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154421352 NPI number — MYLES J SCHNEIDER D.P.M

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHNEIDER
Provider First Name:
MYLES
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.P.M
Provider Gender Code:
M

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:
1154421352
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/15/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11525 WILD HAWTHORN CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RESTON
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
20194-1023
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-750-1124
Provider Business Mailing Address Fax Number:
703-750-2043

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7540 LITTLE RIVER TPKE
Provider Second Line Business Practice Location Address:
SUITE I
Provider Business Practice Location Address City Name:
ANNANDALE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22003-2839
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-750-1124
Provider Business Practice Location Address Fax Number:
703-750-2043
Provider Enumeration Date:
09/25/2006

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: 213E00000X , with the licence number:  0103000245 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 81343 . This is a "MEDICARE RAILROAD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 20194 . This is a "OPT CHICE/MAMSI/ALLIANCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 71220001 . This is a "BLUE CROSS FEDERAL" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 9332294 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4090314 . This is a "AETNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 290570 . This is a "BLUE CROSS VIRIGINIA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 435496 . This is a "SOUTH HEALTH" identifier . This identifiers is of the category "OTHER".




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