Basic Information
| Provider Information | |||||||||
| NPI: | 1699760876 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRYAN | ||||||||
| FirstName: | SEAN | ||||||||
| MiddleName: | TIMOTHY | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 833 CHESTNUT ST STE 520 | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191074430 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2675926191 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1200 MANOR DR | ||||||||
| Address2: | |||||||||
| City: | CHALFONT | ||||||||
| State: | PA | ||||||||
| PostalCode: | 189142282 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8003219999 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/14/2005 | ||||||||
| LastUpdateDate: | 11/03/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QS0010X | 25MA10235500 | NJ | N | Allopathic & Osteopathic Physicians | Family Medicine | Sports Medicine | 207QS1201X | MD063399L | PA | N | Allopathic & Osteopathic Physicians | Family Medicine | Sleep Medicine | 207QS0010X | MD063399L | PA | Y | Allopathic & Osteopathic Physicians | Family Medicine | Sports Medicine |
No ID Information.