MEDICARE: JOHN C PASCHOLD MD

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	174400000X	Specialist	0101059022	VA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00016047	OTHER	VA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	65593	OTHER	VA	OPTIMA

General Provider Information

NPI Number	:	1962407510
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN C PASCHOLD MD

Provider Business Mailing Address
First Line	:	500 SENTARA CIRCLE
Second Line	:	SUITE 203
City	:	WILLIAMSBURG
State	:	VA
Zip	:	23188-5727
Country	:	US
Telephone Number	:	757-229-2236
Fax Number	:	757-221-0409

Provider Business Practice Location Address
First Line	:	500 SENTARA CIRCLE
Second Line	:	SUITE 203
City	:	WILLIAMSBURG
State	:	VA
Zip	:	23188-5727
Country	:	US
Telephone Number	:	757-229-2236
Fax Number	:	757-221-0409

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

Provider Enumeration Date	:	06/20/2005
Last Update Date	:	11/29/2007

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Directions to “ JOHN C PASCHOLD MD” Practice Location

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