Provider Demographics
NPI:1790739886
Name:SCHULTZ, SCOTT D (PA)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:D
Last Name:SCHULTZ
Suffix:
Gender:M
Credentials:PA
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 410
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-2872
Mailing Address - Country:US
Mailing Address - Phone:540-536-6721
Mailing Address - Fax:540-536-6724
Practice Address - Street 1:190 CAMPUS BLVD
Practice Address - Street 2:SUITE 410
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-2872
Practice Address - Country:US
Practice Address - Phone:540-536-6721
Practice Address - Fax:540-536-6724
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110840656363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAS28144Medicare UPIN
VA014871W12Medicare PIN