Healthcare Provider Details

I. General information

NPI: 1295791226
Provider Name (Legal Business Name): JONATHAN PAIGE KUSHNER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 10/16/2025
Certification Date: 10/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4340 CLYO RD STE 200
DAYTON OH
45459
US

IV. Provider business mailing address

4340 CLYO RD STE 200
DAYTON OH
45459-7000
US

V. Phone/Fax

Practice location:
  • Phone: 937-534-7330
  • Fax: 937-395-3682
Mailing address:
  • Phone: 937-396-2602
  • Fax: 937-395-3682

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101042378
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number74853
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35-081060
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number74853
License Number StateTN
# 5
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number0101042378
License Number StateVA
# 6
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number35-081060
License Number StateOH
# 7
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number74853
License Number StateTN
# 8
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number35-081060
License Number StateOH
# 9
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD0487446C
License Number StatePA
# 10
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number0101042378
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: