Provider Demographics
NPI:1164668380
Name:ALBEMARLE CHARLOTTESVILLE PODIATRY ASSOC LTD
Entity Type:Organization
Organization Name:ALBEMARLE CHARLOTTESVILLE PODIATRY ASSOC LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:H
Authorized Official - Last Name:SCHUSTEK
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:434-295-4443
Mailing Address - Street 1:2050 ABBEY RD
Mailing Address - Street 2:STE C
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22911-3553
Mailing Address - Country:US
Mailing Address - Phone:434-295-4443
Mailing Address - Fax:434-295-8598
Practice Address - Street 1:175C SPICERS MILL RD
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:VA
Practice Address - Zip Code:22960-1037
Practice Address - Country:US
Practice Address - Phone:540-672-1402
Practice Address - Fax:540-825-4937
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALBEMARLE CHARLOTTESVILLE PODIATRY ASSOC LTD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-12-17
Last Update Date:2009-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA009301674Medicaid
VA009303081Medicaid
VA480000699Medicare PIN
VA1982633590Medicare PIN
VAU09825Medicare UPIN
VA1962478891Medicare PIN
VA009301674Medicaid
VA0560720002Medicare NSC
VA009303081Medicaid
480000050Medicare PIN