Provider Demographics
NPI:1366424533
Name:SHAFMAN, TIMOTHY D (MD)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:D
Last Name:SHAFMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2234 COLONIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:50 MAUDE ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02908-4325
Practice Address - Country:US
Practice Address - Phone:401-456-2690
Practice Address - Fax:401-456-6540
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA792552085R0001X
FLME1256912085R0001X
RIMD114562085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI822225OtherUSA MNGD. CR. PROV. #
RIAA15549OtherHARV. PILG. PROVIDER #
CT008002447Medicaid
FLP01798845OtherCLEAR HEALTH ALLIANCE
FLP994555OtherFREEDOM
CT010011456RI01OtherANTHEM BCBS CT PROV. #
RI412134OtherBCBS RI - BLUECHIP PROV #
FL015965200Medicaid
RI29025-8OtherBCBS OF RI PROVIDER #
RI5524206OtherAETNA REF/CERT #
MAJ30652OtherBCBS OF MASS PROVIDER #
MAP01107077OtherRAILROAD MCR
MA3133087Medicaid
MA98985603OtherNETWORK HEALTH
RIP00762779OtherRAILROAD MEDICARE - RADIOSURGERY CENTER OF RI
RI30348OtherNEIGHBR. HLTH PL. PROV. #
RI3701804OtherAETNA PROVIDER NUMBER
FL387766OtherAVMED
RI42700OtherHEALTH NEW ENGLAND
RI7057190Medicaid
RIP00693330OtherRAIL ROAD MEDICARE
FLP01580612OtherRR MEDICARE
FL1493289OtherCIGNA
RI1493289OtherCIGNA PROVIDER NUMBER
MA3133087OtherMASS HEALTH PROVIDER #
FL5524206OtherAETNA
FLZS4X3OtherBCBS
RI079255OtherTUFTS HLTH PLN. PROV. #
MAP00762754OtherRAILROAD MEDICARE - CMCCC
FLP971651OtherOPTIMUM
CT008002447Medicaid
MA000299304Medicare PIN
RIP00693330OtherRAIL ROAD MEDICARE
FLZS4X3OtherBCBS
MAJ30652OtherBCBS OF MASS PROVIDER #
CT010011456RI01OtherANTHEM BCBS CT PROV. #
RI1493289OtherCIGNA PROVIDER NUMBER
FL1493289OtherCIGNA
MA3133087Medicaid