Basic Information
| Provider Information | |||||||||
| NPI: | 1780731604 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHAFFER | ||||||||
| FirstName: | EUGENE | ||||||||
| MiddleName: | MICHAEL | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2494 BERNVILLE ROAD | ||||||||
| Address2: | |||||||||
| City: | READING | ||||||||
| State: | PA | ||||||||
| PostalCode: | 196059453 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6102084649 | ||||||||
| FaxNumber: | 6102084640 | ||||||||
| Practice Location | |||||||||
| Address1: | 2494 BERNVILLE ROAD | ||||||||
| Address2: | |||||||||
| City: | READING | ||||||||
| State: | PA | ||||||||
| PostalCode: | 196059453 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6102084649 | ||||||||
| FaxNumber: | 6102084640 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/04/2007 | ||||||||
| LastUpdateDate: | 04/19/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | MD025044E | PA | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 333996 | 01 | PA | HEALTH ASSURANCE | OTHER | 0019634000 | 01 | PA | INDEPENDENCE BLUE CROSS | OTHER | 0019634000 | 01 | PA | KEYSTONE EAST | OTHER | 0019634000 | 01 | PA | PERSONAL CHOICE | OTHER | 02335000 | 01 | PA | CAPITAL BLUE CROSS | OTHER | 08774200001 | 05 | PA | MEDICAID | 232256006 | 01 | PA | BERKSHIRE HEALTH PARTNERS | OTHER | 414753 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER |