Provider Demographics
NPI:1851517171
Name:A BRUCE SHAUER MD PC
Entity Type:Organization
Organization Name:A BRUCE SHAUER MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:SHAUER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-780-6100
Mailing Address - Street 1:2616 SHERWOOD HALL LN
Mailing Address - Street 2:SUITE 205
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22306-3100
Mailing Address - Country:US
Mailing Address - Phone:703-780-6100
Mailing Address - Fax:703-780-2172
Practice Address - Street 1:2616 SHERWOOD HALL LN
Practice Address - Street 2:SUITE 205
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22306-3100
Practice Address - Country:US
Practice Address - Phone:703-780-6100
Practice Address - Fax:703-780-2172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101022749207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006044158Medicaid
VA006044158Medicaid
D09441Medicare UPIN