Provider Demographics
NPI:1396748182
Name:MUFFELMAN, DAVID W (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:W
Last Name:MUFFELMAN
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:PO BOX 693
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23061-0693
Mailing Address - Country:US
Mailing Address - Phone:804-693-6527
Mailing Address - Fax:804-693-6615
Practice Address - Street 1:6790 WOOD RIDGE DRIVE
Practice Address - Street 2:
Practice Address - City:GLOUCESTER
Practice Address - State:VA
Practice Address - Zip Code:23061
Practice Address - Country:US
Practice Address - Phone:804-693-6527
Practice Address - Fax:804-693-6615
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101026776207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA141599OtherBLUE CROSS BLUE SHIELD
VA005902509Medicaid
VA070016971OtherRAILROAD MEDICARE
VA141599OtherBLUE CROSS BLUE SHIELD