Provider Demographics
NPI:1891746822
Name:SHAFER, DONALD T (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:T
Last Name:SHAFER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:DONALD
Other - Middle Name:T
Other - Last Name:SHAFER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3625 N ELM ST
Mailing Address - Street 2:SUITE 110A
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27455-2604
Mailing Address - Country:US
Mailing Address - Phone:336-282-4840
Mailing Address - Fax:336-282-4660
Practice Address - Street 1:3625 N ELM ST
Practice Address - Street 2:SUITE 110A
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27455-2604
Practice Address - Country:US
Practice Address - Phone:336-282-4840
Practice Address - Fax:336-282-4660
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20342207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5714591Medicaid
NC75290OtherBCBS
NC8975290Medicaid
NC75290OtherBCBS
NC8975290Medicaid