Provider Demographics
NPI:1447247689
Name:SHAFFER, BRIAN L (MD)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:L
Last Name:SHAFFER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:133 FRANKLIN CORNER RD
Mailing Address - Street 2:2ND FL
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648-2531
Mailing Address - Country:US
Mailing Address - Phone:609-436-5900
Mailing Address - Fax:609-452-0222
Practice Address - Street 1:133 FRANKLIN CORNER RD
Practice Address - Street 2:2ND FL
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648-2531
Practice Address - Country:US
Practice Address - Phone:609-436-5900
Practice Address - Fax:609-452-0222
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2015-04-02
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA05504600207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E61090Medicare UPIN
E61090Medicare UPIN