Provider Demographics
NPI:1083002679
Name:SCHNEIDER, MATTHEW (IDC)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:SCHNEIDER
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4800 ALICIA DR
Mailing Address - Street 2:ROOM 210
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-3851
Mailing Address - Country:US
Mailing Address - Phone:540-316-1726
Mailing Address - Fax:
Practice Address - Street 1:2520 MIDWAY RD
Practice Address - Street 2:STE 200
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23459-9302
Practice Address - Country:US
Practice Address - Phone:540-316-1726
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-05
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman