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NPI Code Detail

MEDICARE: MCSHANE SPORTS MEDICINE

MEDICARE: MCSHANE SPORTS MEDICINE
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) PhysicianMD055461LPA

General Provider Information

NPI Number : 1831143361
Entity Type Code : Organization
Provider Name (Legal Business Name) : MCSHANE SPORTS MEDICINE
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 : PRESIDENT
Name : DR. JOHN M MCSHANE
Credential : M.D.
Telephone Number : 610-254-8001
Provider Enumeration Date : 05/20/2006
Last Update Date : 08/22/2020

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1063557866 — MCSHANE SPORTS MEDICINE PC
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Directions to “MCSHANE SPORTS MEDICINE ” Practice Location

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