Provider Demographics
NPI:1639115389
Name:SCHENBERG, BRIAN MARK (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:MARK
Last Name:SCHENBERG
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 1:210 TEMPLE AVE
Mailing Address - Street 2:
Mailing Address - City:COLONIAL HEIGHTS
Mailing Address - State:VA
Mailing Address - Zip Code:23834-2828
Mailing Address - Country:US
Mailing Address - Phone:804-520-6137
Mailing Address - Fax:804-520-7394
Practice Address - Street 1:210 TEMPLE AVE
Practice Address - Street 2:
Practice Address - City:COLONIAL HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:23834-2828
Practice Address - Country:US
Practice Address - Phone:804-520-6137
Practice Address - Fax:804-520-7394
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101238784208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1649483967OtherGROUP NPI