Provider Demographics
NPI:1417950981
Name:SHAVER, TIMOTHY RODDY (MD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:RODDY
Last Name:SHAVER
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 1:5290 CHANDLEY FARM CIR
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20120-1235
Mailing Address - Country:US
Mailing Address - Phone:703-371-6155
Mailing Address - Fax:
Practice Address - Street 1:1860 TOWN CENTER DR STE 440
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-5908
Practice Address - Country:US
Practice Address - Phone:571-554-8950
Practice Address - Fax:571-554-8951
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101049305208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC051838700Medicaid
VA010068096Medicaid
VA022949V54Medicare UPIN
DC051838700Medicaid
VA010068096Medicaid