Provider Demographics
NPI:1346616406
Name:BASTIAN, JONATHAN D (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:D
Last Name:BASTIAN
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:1 HOSPITAL DR
Mailing Address - Street 2:SUITE 306
Mailing Address - City:LEWISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17837-9350
Mailing Address - Country:US
Mailing Address - Phone:570-522-4144
Mailing Address - Fax:570-768-3911
Practice Address - Street 1:3 HOSPITAL DR STE 204
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:PA
Practice Address - Zip Code:17837-9394
Practice Address - Country:US
Practice Address - Phone:570-524-6766
Practice Address - Fax:570-524-6841
Is Sole Proprietor?:No
Enumeration Date:2015-08-12
Last Update Date:2022-06-07
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Provider Licenses
StateLicense IDTaxonomies
PA363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant