Provider Demographics
NPI: | 1871573568 |
---|---|
Name: | SCHULT, ALEXANDER A (MD) |
Entity type: | Individual |
Prefix: | |
First Name: | ALEXANDER |
Middle Name: | A |
Last Name: | SCHULT |
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: | 856 J CLYDE MORRIS BLVD STE A |
Mailing Address - Street 2: | |
Mailing Address - City: | NEWPORT NEWS |
Mailing Address - State: | VA |
Mailing Address - Zip Code: | 23601-1318 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 757-316-5800 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 20486 MARKET STREET |
Practice Address - Street 2: | |
Practice Address - City: | ONANCOCK |
Practice Address - State: | VA |
Practice Address - Zip Code: | 23417-2341 |
Practice Address - Country: | US |
Practice Address - Phone: | 757-302-2700 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-01-19 |
Last Update Date: | 2022-10-13 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
VA | 0101222053 | 207RC0200X, 207RP1001X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207RP1001X | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
No | 207RC0200X | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
VA | 016114C54 | Medicare PIN | |
H40384 | Medicare UPIN | ||
VA | P00713154 | Medicare PIN |