Provider Demographics
NPI:1831143361
Name:MCSHANE SPORTS MEDICINE
Entity Type:Organization
Organization Name:MCSHANE SPORTS MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:MCSHANE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-254-8001
Mailing Address - Street 1:734 E LANCASTER AVE
Mailing Address - Street 2:
Mailing Address - City:VILLANOVA
Mailing Address - State:PA
Mailing Address - Zip Code:19085-1325
Mailing Address - Country:US
Mailing Address - Phone:610-254-8001
Mailing Address - Fax:610-254-0911
Practice Address - Street 1:734 E LANCASTER AVE
Practice Address - Street 2:
Practice Address - City:VILLANOVA
Practice Address - State:PA
Practice Address - Zip Code:19085-1325
Practice Address - Country:US
Practice Address - Phone:610-254-8001
Practice Address - Fax:610-254-0911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD055461L207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Single Specialty