Provider Demographics
NPI:1649232331
Name:SCHWENTKER, ANDREW EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:EDWARD
Last Name:SCHWENTKER
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 1:190 CAMPUS BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-2872
Mailing Address - Country:US
Mailing Address - Phone:540-662-6135
Mailing Address - Fax:540-662-5845
Practice Address - Street 1:190 CAMPUS BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-2872
Practice Address - Country:US
Practice Address - Phone:540-662-6135
Practice Address - Fax:540-662-5845
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2021-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101059037207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
02004700000OtherQUAL CHOICE PROFESSIONAL
2119651OtherMAMSI PROFESSIONAL
216523OtherANTHEM PROFESSIONAL
WV3810003817OtherWV MEDICAID GROUP
WV6001112000Medicaid
VA005844631Medicaid
000875693OtherWV BLUE SHIELD GROUP
001717443OtherWV BLUE SHIELD
28556OtherSENTARA PROFESSIONAL
C00085OtherVA MEDICARE B GROUP
216523OtherANTHEM PROFESSIONAL
H13901Medicare UPIN