Individual
DR. TIMOTHY RODDY SHAVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1860 TOWN CENTER DR STE 440, RESTON, VA 20190-5908
(571) 554-8950
(571) 554-8951
Mailing address
5290 CHANDLEY FARM CIR, CENTREVILLE, VA 20120-1235
(703) 371-6155
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
0101049305
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010068096
—
VA
05
—
051838700
—
DC
Enumeration date
05/27/2005
Last updated
03/17/2023
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