Provider Demographics
NPI:1982633590
Name:SCHUSTEK, SAMUEL HOWARD (DPM)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:HOWARD
Last Name:SCHUSTEK
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2050 ABBEY RD
Mailing Address - Street 2:STE C
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22911-3553
Mailing Address - Country:US
Mailing Address - Phone:434-295-4443
Mailing Address - Fax:434-295-8598
Practice Address - Street 1:2050 ABBEY RD
Practice Address - Street 2:STE C
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22911-3553
Practice Address - Country:US
Practice Address - Phone:434-295-4443
Practice Address - Fax:434-295-8598
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103000589213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1548333842OtherTYPE 2 NPI
VA009301674Medicaid
VA1164668380Medicare PIN
VA0560720002Medicare NSC
VA009301674Medicaid
VA480000050Medicare PIN
VA1548333842OtherTYPE 2 NPI
VA0560720003Medicare NSC
VA1134365786Medicare PIN