Provider Demographics
NPI:1346385457
Name:SHAFFER, WARREN BASIL (MD)
Entity Type:Individual
Prefix:DR
First Name:WARREN
Middle Name:BASIL
Last Name:SHAFFER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2867 DUKE ST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-4512
Mailing Address - Country:US
Mailing Address - Phone:703-212-7397
Mailing Address - Fax:703-212-7399
Practice Address - Street 1:2867 DUKE ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-4512
Practice Address - Country:US
Practice Address - Phone:703-212-7397
Practice Address - Fax:703-212-7399
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101057177207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0101057177OtherSTATE LICENSE NUMBER
BS5769433OtherFEDERAL DEA NUMBER
491529Medicare ID - Type Unspecified
BS5769433OtherFEDERAL DEA NUMBER