Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | MD026496E | PA |
NPI | 1326040528 |
---|---|
Provider Name | Elliott L Schaffer |
First Address | Broomall, PA 19008-4202 |
Second Address | Havertown, PA 19083-4530 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2005 |
Last Update Date | 16/07/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0014355950001 | (05) | PA |