Provider Demographics
NPI:1780089516
Name:BRIAN D SHANNON MD ADVANCED SPINE AND ORTHOPAEDICS LLC
Entity type:Organization
Organization Name:BRIAN D SHANNON MD ADVANCED SPINE AND ORTHOPAEDICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:SHANNON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-598-2020
Mailing Address - Street 1:752 BROOKSHIRE DR
Mailing Address - Street 2:SUITE 3
Mailing Address - City:HERMITAGE
Mailing Address - State:PA
Mailing Address - Zip Code:16148-4510
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:752 BROOKSHIRE DR
Practice Address - Street 2:SUITE 3
Practice Address - City:HERMITAGE
Practice Address - State:PA
Practice Address - Zip Code:16148-4510
Practice Address - Country:US
Practice Address - Phone:724-598-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-22
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty