Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | DC007214L | PA |
NPI | 1962591636 |
---|---|
Provider Name | Dr. Shayne N Bushong |
First Address | Lancaster, PA 17601-4001 |
Second Address | Lancaster, PA 17601-4001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2006 |
Last Update Date | 29/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U70264 | (02) | PA |