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NPI Code Detail

MEDICARE: MS. AMY M BUSTIN PA-C

MEDICARE:  MS. AMY M BUSTIN  PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AM0700XMedical Physician AssistantMA051630PA

General Provider Information

NPI Number : 1982643920
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. AMY M BUSTIN PA-C
Provider Business Mailing Address
First Line : 1015 CHESTNUT ST
Second Line : SUITE 821
City : PHILADELPHIA
State : PA
Zip : 19107-4316
Country : US
Telephone Number : 215-922-1801
Fax Number : 215-922-1806
Provider Business Practice Location Address
First Line : 1015 CHESTNUT ST
Second Line : SUITE 821
City : PHILADELPHIA
State : PA
Zip : 19107-4316
Country : US
Telephone Number : 215-922-1801
Fax Number : 215-922-1806
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/05/2006
Last Update Date : 02/05/2009

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