Provider Demographics
NPI:1851378301
Name:SHIFF, BRIAN MATHEW (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:MATHEW
Last Name:SHIFF
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 1:2055 HOSPITAL DR
Mailing Address - Street 2:STE. 355
Mailing Address - City:BATAVIA
Mailing Address - State:OH
Mailing Address - Zip Code:45103-1978
Mailing Address - Country:US
Mailing Address - Phone:513-732-9300
Mailing Address - Fax:513-732-5663
Practice Address - Street 1:2055 HOSPITAL DR
Practice Address - Street 2:STE. 355
Practice Address - City:BATAVIA
Practice Address - State:OH
Practice Address - Zip Code:45103-1978
Practice Address - Country:US
Practice Address - Phone:513-732-9300
Practice Address - Fax:513-732-5663
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35074200208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2054155Medicaid
OHSH0847221Medicare PIN
OH2054155Medicaid
OHSH4040012Medicare PIN
OHH163380Medicare PIN
OHG73058Medicare UPIN