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NPI Code Detail

MEDICARE: MCSHANE SPORTS MEDICINE PC

MEDICARE: MCSHANE SPORTS MEDICINE PC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1213E00000XPodiatrist

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1906548OTHERHIGHMARK BS

General Provider Information

NPI Number : 1063557866
Entity Type Code : Organization
Provider Name (Legal Business Name) : MCSHANE SPORTS MEDICINE PC
Provider Business Mailing Address
First Line : 734 E LANCASTER AVE
Second Line :
City : VILLANOVA
State : PA
Zip : 19085-1325
Country : US
Telephone Number : 610-254-8001
Fax Number : 610-254-0911
Provider Business Practice Location Address
First Line : 734 E LANCASTER AVE
Second Line :
City : VILLANOVA
State : PA
Zip : 19085-1325
Country : US
Telephone Number : 610-254-8001
Fax Number : 610-254-0911
Authorized Official
Title or Position : OWNER
Name : JOHN MCSHANE
Credential : MD
Telephone Number : 610-254-8001
Provider Enumeration Date : 02/20/2007
Last Update Date : 03/10/2014

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Directions to “MCSHANE SPORTS MEDICINE PC ” Practice Location

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