Provider Demographics
NPI:1700840923
Name:BRYANT, DAVID SHAUN (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:SHAUN
Last Name:BRYANT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:785 5TH AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-4232
Mailing Address - Country:US
Mailing Address - Phone:717-263-9555
Mailing Address - Fax:717-217-4217
Practice Address - Street 1:120 N 7TH ST STE 200
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-1795
Practice Address - Country:US
Practice Address - Phone:717-217-6800
Practice Address - Fax:717-217-6900
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2009-00124208600000X
PAMD068495L208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA8455857OtherAETNA HMO
PA000544344OtherHIGHMARK BLUE SHIELD
NC15103OtherBCBSNC
PA7716062OtherAETNA NON HMO
PAP01094191OtherRAILROAD MEDICARE
PA0017470000003Medicaid
PA001747000 0005Medicaid
NC5911173Medicaid
P00309980OtherRAILROAD MEDICARE
NC2073194Medicare PIN
PAP01094191OtherRAILROAD MEDICARE
099646Medicare PIN
PA000544344OtherHIGHMARK BLUE SHIELD