Basic Information
| Provider Information | |||||||||
| NPI: | 1982633590 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SCHUSTEK | ||||||||
| FirstName: | SAMUEL | ||||||||
| MiddleName: | HOWARD | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DPM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2050 ABBEY RD | ||||||||
| Address2: | STE C | ||||||||
| City: | CHARLOTTESVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 229113553 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4342954443 | ||||||||
| FaxNumber: | 4342958598 | ||||||||
| Practice Location | |||||||||
| Address1: | 2050 ABBEY RD | ||||||||
| Address2: | STE C | ||||||||
| City: | CHARLOTTESVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 229113553 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4342954443 | ||||||||
| FaxNumber: | 4342958598 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/03/2006 | ||||||||
| LastUpdateDate: | 11/28/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213ES0131X | 0103000589 | VA | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot Surgery |
ID Information
| ID | Type | State | Issuer | Description | 1548333842 | 01 | VA | TYPE 2 NPI | OTHER | 009301674 | 05 | VA | MEDICAID |