Healthcare Provider Details

I. General information

NPI: 1114900768
Provider Name (Legal Business Name): PHILIP A SCHULTZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2005
Last Update Date: 04/28/2021
Certification Date: 04/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1002-C AMHERST STREET
WINCHESTER VA
22601
US

IV. Provider business mailing address

1002-C AMHERST STREET
WINCHESTER VA
22601
US

V. Phone/Fax

Practice location:
  • Phone: 540-662-3853
  • Fax: 540-662-0336
Mailing address:
  • Phone: 540-662-3853
  • Fax: 540-662-0336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101241744
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0420010068
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: