Provider Demographics
NPI:1043323454
Name:SCHOEFFEL, MARK EDWIN (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:EDWIN
Last Name:SCHOEFFEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 TENTH ST NE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22902-5316
Mailing Address - Country:US
Mailing Address - Phone:434-296-7733
Mailing Address - Fax:434-296-7740
Practice Address - Street 1:459 LOCUST AVENUE
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22902-5316
Practice Address - Country:US
Practice Address - Phone:434-296-7733
Practice Address - Fax:434-296-7740
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101035253207L00000X
VA0101035259207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA003163A76Medicare PIN
B07044Medicare UPIN