1104889740 NPI number — ANDREW C SCHUTRUMPF MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104889740 NPI number — ANDREW C SCHUTRUMPF MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

SCHUTRUMPF

Provider First Name:

ANDREW

Provider Middle Name:

C

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

M

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:

1104889740

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

08/04/2023

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

905 HANSHAW RD STE C

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

ITHACA

Provider Business Mailing Address State Name:

NY

Provider Business Mailing Address Postal Code:

14850-1549

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

804-387-2328

Provider Business Mailing Address Fax Number:

607-319-0492

Provider First Line Business Practice Location Address:

905 HANSHAW RD STE C

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

ITHACA

Provider Business Practice Location Address State Name:

NY

Provider Business Practice Location Address Postal Code:

14850-1549

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

804-387-2328

Provider Business Practice Location Address Fax Number:

607-319-0492

Provider Enumeration Date:

04/06/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207R00000X , with the licence number:  0101056695 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207R00000X , with the licence number: 184266 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 292573 . This is a "MAMSI" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 110217727 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 4902989 . This is a "CIGNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 5569579 . This is a "AETNA LIFE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 43931 . This is a "SENTARA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: C06689 . This is a "GROUP PTAN" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 122921 . This is a "SOUTHERN HEALTH SERVICES" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 228139 . This is a "ANTHEM BCBS OF VA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 5569579 . This is a "AETNA HMO" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 010017033 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".