Provider Demographics
NPI:1548333842
Name:ALBEMARLE CHARLOTTESVILLE PODIATRY ASSOCIATES LTD
Entity type:Organization
Organization Name:ALBEMARLE CHARLOTTESVILLE PODIATRY ASSOCIATES LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
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:SUITE 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:SUITE 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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2013-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA009301674Medicaid
VA009303081Medicaid
VAU09825Medicare UPIN
VA009301674Medicaid
VA0560720003Medicare NSC
VA1982633590Medicare PIN
VA1962478891Medicare PIN
VA009303081Medicaid
VA0560720002Medicare NSC
VA0560720001Medicare NSC