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General NPI Number Information
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NPI Number | 1679535041
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Entity Type | Organization
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Legal Business Name | BRADFORD ORTHOPAEDIC & SPORTS MEDICINE GROUP, PC
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Dates
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Enumeration Date | 04/03/2006
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Last Update Date | 08/29/2008
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Provider Practice Location Address
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Address Line | 54 BOYLSTON ST 2ND FLOOR
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City | BRADFORD
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State | PA
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Zip | 16701-2007
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Country | US
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Telephone | 814-368-1020
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Fax | 814-368-1024
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Provider Business Mailing Address
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Address Line | 54 BOYLSTON ST 2ND FLOOR
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City | BRADFORD
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State | PA
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Zip | 16701-2007
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Country | US
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Telephone | 814-368-1020
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Fax | 814-368-1024
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. SHABIR BHAYANI
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Credential | MD
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Telephone | 814-368-1010
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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