Healthcare Provider Details

I. General information

NPI: 1346385457
Provider Name (Legal Business Name): WARREN BASIL SHAFFER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2867 DUKE ST
ALEXANDRIA VA
22314-4512
US

IV. Provider business mailing address

2867 DUKE ST
ALEXANDRIA VA
22314-4512
US

V. Phone/Fax

Practice location:
  • Phone: 703-212-7397
  • Fax: 703-212-7399
Mailing address:
  • Phone: 703-212-7397
  • Fax: 703-212-7399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number0101057177
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: