Basic Information
Provider Information | |||||||||
NPI: | 1912900861 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | SCHINDERLE | ||||||||
FirstName: | DAVID | ||||||||
MiddleName: | B | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 138 S ROSEMONT RD | ||||||||
Address2: | STE 215 | ||||||||
City: | VIRGINIA BEACH | ||||||||
State: | VA | ||||||||
PostalCode: | 234524336 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7574319551 | ||||||||
FaxNumber: | 7574319663 | ||||||||
Practice Location | |||||||||
Address1: | 138 S ROSEMONT RD | ||||||||
Address2: | STE 215 | ||||||||
City: | VIRGINIA BEACH | ||||||||
State: | VA | ||||||||
PostalCode: | 234524336 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7574319551 | ||||||||
FaxNumber: | 7574319663 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/24/2005 | ||||||||
LastUpdateDate: | 07/09/2007 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | X | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 0101232422 | VA | Y |   | Allopathic & Osteopathic Physicians | Anesthesiology |   |
ID Information
ID | Type | State | Issuer | Description | 065AT | 01 | NC | BC BS OF NORTH CAROLINA | OTHER | 89065AT | 05 | NC |   | MEDICAID | 287539 | 01 | VA | ANTHEM OF VIRGINIA | OTHER | 52053 | 01 | VA | OPTIMA SENTARA | OTHER |