Provider Demographics
NPI:1578861324
Name:SCHEINERT, EDWARD WILLIAM (IDC)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:WILLIAM
Last Name:SCHEINERT
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2424 RENDOVA RD SUITE 156
Mailing Address - Street 2:NSWG-1 LOGSUPPU
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92155-5401
Mailing Address - Country:US
Mailing Address - Phone:619-437-5612
Mailing Address - Fax:
Practice Address - Street 1:2424 RENDOVA RD SUITE 156
Practice Address - Street 2:NSWG-1 LOGSUPPU
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92155-5401
Practice Address - Country:US
Practice Address - Phone:619-437-5612
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-03
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman