Provider Demographics
NPI:1386786002
Name:SCHIFFBAUER, TERRY DALE (PA-C)
Entity type:Individual
Prefix:MR
First Name:TERRY
Middle Name:DALE
Last Name:SCHIFFBAUER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:394 GARRISONVILLE RD. STE 103
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22554
Mailing Address - Country:US
Mailing Address - Phone:540-374-5599
Mailing Address - Fax:
Practice Address - Street 1:394 GARRISONVILLE RD STE 103
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-1529
Practice Address - Country:US
Practice Address - Phone:540-374-5599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110004436207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810019122Medicaid
WV2034305Medicare PIN
WVPA 77051Medicare ID - Type Unspecified
WV2034302Medicare PIN
WVP66516Medicare UPIN
WV2034304Medicare PIN
WV2034307Medicare PIN
WV2034303Medicare PIN
WV3810019122Medicaid
WV2034306Medicare PIN