Provider Demographics
NPI:1477509644
Name:SCHMIDT, EDWARD B (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:B
Last Name:SCHMIDT
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:PO BOX 9007
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22906-9007
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1215 LEE ST FL 1
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22908-1029
Practice Address - Country:US
Practice Address - Phone:434-924-9400
Practice Address - Fax:434-243-6999
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2018-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010764572085R0202X
OH35.1231442085R0202X
PAMD044643E2085R0202X
VA01010516812085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2682676OtherHIGHMARK BCBS
PA1026746170001Medicaid
VA1477509644Medicaid
MI32624500Medicaid
OH0076674Medicaid
MI4979643Medicaid
MICA3518OtherMEDICARE RR GROUP PIN
MI0D46002OtherBCBS GROUP PIN
MI0F36125OtherBCBS GROUP PIN
PA2682676OtherHIGHMARK BCBS
G23916Medicare UPIN
MI32624500Medicaid
MI0F36125Medicare PIN