Provider Demographics
NPI:1780731604
Name:SHAFFER, EUGENE MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:EUGENE
Middle Name:MICHAEL
Last Name:SHAFFER
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 1:2494 BERNVILLE ROAD
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19605-9453
Mailing Address - Country:US
Mailing Address - Phone:610-208-4649
Mailing Address - Fax:610-208-4640
Practice Address - Street 1:2494 BERNVILLE ROAD
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19605-9453
Practice Address - Country:US
Practice Address - Phone:610-208-4649
Practice Address - Fax:610-208-4640
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2010-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD025044E208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA333996OtherHEALTH ASSURANCE
PA0019634000OtherINDEPENDENCE BLUE CROSS
PA0019634000OtherKEYSTONE EAST
PA0019634000OtherPERSONAL CHOICE
PA02335000OtherCAPITAL BLUE CROSS
PA08774200001Medicaid
PA232256006OtherBERKSHIRE HEALTH PARTNERS
PA414753OtherHIGHMARK BLUE SHIELD
PA0019634000OtherPERSONAL CHOICE
PA333996OtherHEALTH ASSURANCE