Provider Demographics
NPI:1497847461
Name:SHIFFMAN, MITCHELL L (MD)
Entity Type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:L
Last Name:SHIFFMAN
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 1:12720 MCMANUS BLVD
Mailing Address - Street 2:SUITE 313
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23602-4414
Mailing Address - Country:US
Mailing Address - Phone:757-947-3190
Mailing Address - Fax:757-947-3195
Practice Address - Street 1:12720 MCMANUS BLVD
Practice Address - Street 2:SUITE 313
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23602-4414
Practice Address - Country:US
Practice Address - Phone:757-947-3190
Practice Address - Fax:757-947-3195
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101036976207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006000924Medicaid
VAC06778OtherMEDICARE GROUP PIN
VAC06778OtherMEDICARE GROUP PIN