Basic Information
| Provider Information | |||||||||
| NPI: | 1700840923 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRYANT | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | SHAUN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 785 5TH AVE | ||||||||
| Address2: | SUITE 3 | ||||||||
| City: | CHAMBERSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 172014232 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172639555 | ||||||||
| FaxNumber: | 7172174217 | ||||||||
| Practice Location | |||||||||
| Address1: | 120 N 7TH ST STE 200 | ||||||||
| Address2: | |||||||||
| City: | CHAMBERSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 172011795 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172176800 | ||||||||
| FaxNumber: | 7172176900 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/14/2006 | ||||||||
| LastUpdateDate: | 06/26/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/26/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 2009-00124 | NC | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | MD068495L | PA | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 8455857 | 01 | PA | AETNA HMO | OTHER | 000544344 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER | 15103 | 01 | NC | BCBSNC | OTHER | 7716062 | 01 | PA | AETNA NON HMO | OTHER | P01094191 | 01 | PA | RAILROAD MEDICARE | OTHER | 0017470000003 | 05 | PA | MEDICAID | 001747000 0005 | 05 | PA | MEDICAID | 5911173 | 05 | NC | MEDICAID | P00309980 | 01 | RAILROAD MEDICARE | OTHER |