Provider Demographics
NPI: | 1538135355 |
---|---|
Name: | SCHUELLEIN, PAUL ROBERT (MD) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | PAUL |
Middle Name: | ROBERT |
Last Name: | SCHUELLEIN |
Suffix: | |
Gender: | M |
Credentials: | MD |
Other - Prefix: | DR |
Other - First Name: | PAUL |
Other - Middle Name: | R |
Other - Last Name: | SCHUELLEIN |
Other - Suffix: | |
Other - Last Name Type: | Other Name |
Other - Credentials: | MD |
Mailing Address - Street 1: | 112 MEDICAL DR |
Mailing Address - Street 2: | |
Mailing Address - City: | ELIZABETH CITY |
Mailing Address - State: | NC |
Mailing Address - Zip Code: | 27909-3361 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 252-384-2610 |
Mailing Address - Fax: | 844-494-0230 |
Practice Address - Street 1: | 112 MEDICAL DR |
Practice Address - Street 2: | |
Practice Address - City: | ELIZABETH CITY |
Practice Address - State: | NC |
Practice Address - Zip Code: | 27909-3361 |
Practice Address - Country: | US |
Practice Address - Phone: | 252-384-2610 |
Practice Address - Fax: | 844-494-0230 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-02-23 |
Last Update Date: | 2023-06-27 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
VA | 0101-048710 | 207V00000X |
NC | 2015-00231 | 207V00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
VA | 6212026 | Medicaid | |
F69543 | Medicare UPIN | ||
160001541 | Medicare ID - Type Unspecified | ||
VA | 6212026 | Medicaid |