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General NPI Number Information
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NPI Number | 1538330519
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Entity Type | Organization
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Legal Business Name | MATTHEW SHAFFER MD PLLC
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Dates
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Enumeration Date | 03/18/2008
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Last Update Date | 03/18/2008
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Provider Practice Location Address
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Address Line | 331 LAIDLEY ST SUITE 601
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City | CHARLESTON
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State | WV
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Zip | 25301-1619
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Country | US
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Telephone | 304-205-5216
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Fax |
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Provider Business Mailing Address
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Address Line | 1822 ROUNDHILL RD
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City | CHARLESTON
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State | WV
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Zip | 25314-1538
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Country | US
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Telephone | 304-205-5216
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MATTHEW JAMES SHAFFER
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Credential | M.D.
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Telephone | 304-205-5216
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 22835
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License Number State | WV
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