Healthcare Provider Details

I. General information

NPI: 1154421352
Provider Name (Legal Business Name): MYLES J SCHNEIDER D.P.M
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 12/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7540 LITTLE RIVER TPKE SUITE I
ANNANDALE VA
22003-2839
US

IV. Provider business mailing address

11525 WILD HAWTHORN CT
RESTON VA
20194-1023
US

V. Phone/Fax

Practice location:
  • Phone: 703-750-1124
  • Fax: 703-750-2043
Mailing address:
  • Phone: 703-750-1124
  • Fax: 703-750-2043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number0103000245
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: