MEDICARE: DR. BRIAN D SHANNON M.D.

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
1	174400000X	Specialist	MD418206	PA
2	207X00000X	Orthopaedic Surgery Physician	MD418206	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1891765673
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN D SHANNON M.D.

Provider Business Mailing Address
First Line	:	752 BROOKSHIRE DR
Second Line	:	SUITE 3
City	:	HERMITAGE
State	:	PA
Zip	:	16148-4510
Country	:	US
Telephone Number	:	724-981-9310
Fax Number	:	724-981-9312

Provider Business Practice Location Address
First Line	:	752 BROOKSHIRE DR
Second Line	:	SUITE 3
City	:	HERMITAGE
State	:	PA
Zip	:	16148-4510
Country	:	US
Telephone Number	:	724-981-9310
Fax Number	:	724-981-9312

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/25/2006
Last Update Date	:	03/08/2016

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Directions to “ DR. BRIAN D SHANNON M.D.” Practice Location

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