MEDICARE: DR. DAVID W MUFFELMAN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	0101026776	VA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	070016971	OTHER	VA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	141599	OTHER	VA	BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396748182
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID W MUFFELMAN M.D.

Provider Business Mailing Address
First Line	:	PO BOX 693
Second Line	:
City	:	GLOUCESTER
State	:	VA
Zip	:	23061-0693
Country	:	US
Telephone Number	:	804-693-6527
Fax Number	:	804-693-6615

Provider Business Practice Location Address
First Line	:	6790 WOOD RIDGE DRIVE
Second Line	:
City	:	GLOUCESTER
State	:	VA
Zip	:	23061
Country	:	US
Telephone Number	:	804-693-6527
Fax Number	:	804-693-6615

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	07/22/2010

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