Basic Information
| Provider Information | |||||||||
| NPI: | 1285097667 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | BIFANO | ||||||||
| FirstName: | SHAWN | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 783311 | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191783311 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 334 MAIN ST | ||||||||
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| City: | DICKSON CITY | ||||||||
| State: | PA | ||||||||
| PostalCode: | 185191668 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6104028900 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/01/2016 | ||||||||
| LastUpdateDate: | 08/19/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | MD465395 | PA | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.