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NPI Code Detail

MEDICARE: DR. SEAN TIMOTHY BRYAN M.D.

MEDICARE: DR. SEAN TIMOTHY BRYAN 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
1207QS0010XSports Medicine (Family Medicine) Physician25MA10235500NJ
2207QS0010XSports Medicine (Family Medicine) PhysicianMD063399LPA

General Provider Information

NPI Number : 1699760876
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SEAN TIMOTHY BRYAN M.D.
Provider Business Mailing Address
First Line : 833 CHESTNUT ST STE 520
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19107-4430
Country : US
Telephone Number : 267-592-6191
Fax Number :
Provider Business Practice Location Address
First Line : 1200 MANOR DR
Second Line :
City : CHALFONT
State : PA
Zip : 18914-2282
Country : US
Telephone Number : 800-321-9999
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/14/2005
Last Update Date : 10/07/2024

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