Provider Demographics
NPI:1710912035
Name:SHAUER, ALAN BRUCE (MD)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:BRUCE
Last Name:SHAUER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:A
Other - Middle Name:BRUCE
Other - Last Name:SHAUER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2616 SHERWOOD HALL LANE
Mailing Address - Street 2:STE 205
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22306-3154
Mailing Address - Country:US
Mailing Address - Phone:703-780-6100
Mailing Address - Fax:703-780-2172
Practice Address - Street 1:2616 SHERWOOD HALL LANE
Practice Address - Street 2:STE 205
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22306-3154
Practice Address - Country:US
Practice Address - Phone:703-780-6100
Practice Address - Fax:703-780-2172
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101022749207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
D09441Medicare UPIN
172851Medicare ID - Type Unspecified