Provider Demographics
NPI:1376614800
Name:SCHUMANN DERMATOLOGY GROUP PC
Entity Type:Organization
Organization Name:SCHUMANN DERMATOLOGY GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:W
Authorized Official - Last Name:SCHUMANN MD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-564-1200
Mailing Address - Street 1:302 BULIFANTS BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-5738
Mailing Address - Country:US
Mailing Address - Phone:757-564-1200
Mailing Address - Fax:757-564-0034
Practice Address - Street 1:302 BULIFANTS BLVD STE 101
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-5738
Practice Address - Country:US
Practice Address - Phone:757-564-1200
Practice Address - Fax:757-564-0034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101226511174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA285595OtherANTHEM BC BS
VA37187OtherOPTIMA PPO
VAC06727Medicare ID - Type Unspecified
VAH31874Medicare UPIN
VA070015852Medicare ID - Type UnspecifiedRAIL ROAD
VA285595OtherANTHEM BC BS