Provider Demographics
NPI:1134365786
Name:ALBEMARLE CHARLOTTESVILLE PODIAT ASSOCIATES LTD
Entity type:Organization
Organization Name:ALBEMARLE CHARLOTTESVILLE PODIAT ASSOCIATES LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:H
Authorized Official - Last Name:SCHUSTEK
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:434-295-4443
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 1:530 SUNSET LN
Practice Address - Street 2:
Practice Address - City:CULPEPER
Practice Address - State:VA
Practice Address - Zip Code:22701-3981
Practice Address - Country:US
Practice Address - Phone:540-825-6113
Practice Address - Fax:540-825-4937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-05
Last Update Date:2013-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103300834213E00000X
VA0103000589213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA009303081Medicaid
VA009301674Medicaid
VA009303081Medicaid
VA1982633590Medicare PIN
VA009301674Medicaid
VAU09825Medicare UPIN
VAU84793Medicare UPIN