Provider Demographics
NPI:1730180696
Name:SCHALLER, VINCENT E (MD)
Entity type:Individual
Prefix:
First Name:VINCENT
Middle Name:E
Last Name:SCHALLER
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 1:1205 KINTERRA CT
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19382-6976
Mailing Address - Country:US
Mailing Address - Phone:302-235-8808
Mailing Address - Fax:302-235-8815
Practice Address - Street 1:5936 LIMESTONE RD STE 301B
Practice Address - Street 2:
Practice Address - City:HOCKESSIN
Practice Address - State:DE
Practice Address - Zip Code:19707-8930
Practice Address - Country:US
Practice Address - Phone:302-234-4000
Practice Address - Fax:302-234-4315
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10004737207Q00000X, 208D00000X
PAMD425156208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1012007330059Medicaid
DE250387542Medicaid
DE050541299OtherTAX ID