Provider Demographics
NPI:1033294079
Name:SCHELERT, EDWARD V (PA-C)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:V
Last Name:SCHELERT
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 POWELL ST
Mailing Address - Street 2:SUITE 900
Mailing Address - City:EMERYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94608-1826
Mailing Address - Country:US
Mailing Address - Phone:510-350-2600
Mailing Address - Fax:
Practice Address - Street 1:400 NORTH PEPPER AVE
Practice Address - Street 2:ARROWHEAD REGIONAL MEDICAL CENTER
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324
Practice Address - Country:US
Practice Address - Phone:909-580-1000
Practice Address - Fax:909-580-3333
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA1022363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1073436OtherNCCPA CERTIFICATION
11934115OtherCAQH
11934115OtherCAQH
NV1073436OtherNCCPA CERTIFICATION
NVV103300Medicare PIN