Basic Information
Provider Information | |||||||||
NPI: | 1831164359 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | SCHINCO SCHAFFER | ||||||||
FirstName: | MIREN | ||||||||
MiddleName: | AVA | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1701 N GEORGE MASON DR STE 304 | ||||||||
Address2: |   | ||||||||
City: | ARLINGTON | ||||||||
State: | VA | ||||||||
PostalCode: | 222053610 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2026776038 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 1625 N GEORGE MASON DR | ||||||||
Address2: |   | ||||||||
City: | ARLINGTON | ||||||||
State: | VA | ||||||||
PostalCode: | 222053683 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7035585000 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 02/19/2006 | ||||||||
LastUpdateDate: | 10/01/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 10/01/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | ME78698 | FL | N |   | Allopathic & Osteopathic Physicians | Surgery |   | 208600000X | 0101272770 | VA | N |   | Allopathic & Osteopathic Physicians | Surgery |   | 2086S0102X | ME78698 | FL | N |   | Allopathic & Osteopathic Physicians | Surgery | Surgical Critical Care | 208600000X | 2015-01379 | NC | Y |   | Allopathic & Osteopathic Physicians | Surgery |   |
ID Information
ID | Type | State | Issuer | Description | 020036013 | 01 | FL | RAILROAD MEDICARE | OTHER | 2522934-00 | 05 | FL |   | MEDICAID | 000758029A | 05 | GA |   | MEDICAID |