Healthcare Provider Details

I. General information

NPI: 1679535041
Provider Name (Legal Business Name): BRADFORD ORTHOPAEDIC & SPORTS MEDICINE GROUP, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2006
Last Update Date: 08/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54 BOYLSTON ST 2ND FLOOR
BRADFORD PA
16701-2007
US

IV. Provider business mailing address

54 BOYLSTON ST 2ND FLOOR
BRADFORD PA
16701-2007
US

V. Phone/Fax

Practice location:
  • Phone: 814-368-1020
  • Fax: 814-368-1024
Mailing address:
  • Phone: 814-368-1020
  • Fax: 814-368-1024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SHABIR BHAYANI
Title or Position: PHYSICIAN
Credential: MD
Phone: 814-368-1010