Provider Demographics
NPI:1174503833
Name:SCHULTE, CHARLES J A III (MD)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:J A
Last Name:SCHULTE
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:10400 EATON PLACE
Mailing Address - Street 2:#410
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030
Mailing Address - Country:US
Mailing Address - Phone:703-359-5160
Mailing Address - Fax:703-383-9574
Practice Address - Street 1:20 PIDGEON HILL DR
Practice Address - Street 2:#202
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20165
Practice Address - Country:US
Practice Address - Phone:703-444-1144
Practice Address - Fax:703-444-6679
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-19
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101025377208000000X
MDD0016866208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
C61627Medicare UPIN