Provider Demographics
NPI:1003809112
Name:TISCHLER, JAY I (DPM)
Entity Type:Individual
Prefix:MR
First Name:JAY
Middle Name:I
Last Name:TISCHLER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1080 FIRST COLONIAL RD
Mailing Address - Street 2:STE 400
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-2406
Mailing Address - Country:US
Mailing Address - Phone:757-395-1880
Mailing Address - Fax:757-431-7770
Practice Address - Street 1:1080 FIRST COLONIAL RD
Practice Address - Street 2:STE 400
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-2406
Practice Address - Country:US
Practice Address - Phone:757-395-1880
Practice Address - Fax:757-431-7770
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103000360213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA011560OtherANTHEM PROVIDER NUMBER
VA9301071Medicaid
VA15423OtherOPTIMA PROVIDER NUMBER
VA311651OtherMDIPA MAMSI PROVIDER NUMB
VA311651OtherMDIPA MAMSI PROVIDER NUMB
VA9301071Medicaid
VA480936014Medicare Oscar/Certification
VAT21387Medicare UPIN
VA0767720002Medicare NSC