Healthcare Provider Details

I. General information

NPI: 1639115389
Provider Name (Legal Business Name): BRIAN MARK SCHENBERG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 05/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 TEMPLE AVE
COLONIAL HEIGHTS VA
23834-2828
US

IV. Provider business mailing address

210 TEMPLE AVE
COLONIAL HEIGHTS VA
23834-2828
US

V. Phone/Fax

Practice location:
  • Phone: 804-520-6137
  • Fax: 804-520-7394
Mailing address:
  • Phone: 804-520-6137
  • Fax: 804-520-7394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101238784
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: