MEDICARE: MR. JAY I TISCHLER DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0103X	Foot & Ankle Surgery Podiatrist	0103000360	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	011560	OTHER	VA	ANTHEM PROVIDER NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	15423	OTHER	VA	OPTIMA PROVIDER NUMBER
4	311651	OTHER	VA	MDIPA MAMSI PROVIDER NUMB

General Provider Information

NPI Number	:	1003809112
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAY I TISCHLER DPM

Provider Business Mailing Address
First Line	:	1080 FIRST COLONIAL RD
Second Line	:	STE 400
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23454-2406
Country	:	US
Telephone Number	:	757-395-1880
Fax Number	:	757-431-7770

Provider Business Practice Location Address
First Line	:	1080 FIRST COLONIAL RD
Second Line	:	STE 400
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23454-2406
Country	:	US
Telephone Number	:	757-395-1880
Fax Number	:	757-431-7770

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/24/2005
Last Update Date	:	09/15/2014

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Directions to “ MR. JAY I TISCHLER DPM” Practice Location

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