Provider Demographics
NPI:1184615221
Name:SHAFFER, DAVID N (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:N
Last Name:SHAFFER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7503 SURRATTS RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-3358
Mailing Address - Country:US
Mailing Address - Phone:301-870-7001
Mailing Address - Fax:301-870-6697
Practice Address - Street 1:7503 SURRATTS RD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-3358
Practice Address - Country:US
Practice Address - Phone:301-870-7001
Practice Address - Fax:301-870-6697
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0014184207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1851473722OtherGROUP NPI - MEDICAL & SURGICAL CLINICS OF SOUTHERN MARYLAND
MD748401100Medicaid
DCB776-0026OtherBCBS DC FOR MEDICAL & SURGICAL CLINICS OF SOUTHERN MARYLAND
MD35122303OtherBCBS MD FOR MEDICAL & SURGICAL CLINICS OF SOUTHERN MARYLAND
MD1760406110OtherGROUP NPI - SMHC OBGYN SERVICES
MD748401100Medicaid
MD1851473722OtherGROUP NPI - MEDICAL & SURGICAL CLINICS OF SOUTHERN MARYLAND
MD1760406110OtherGROUP NPI - SMHC OBGYN SERVICES