Provider Demographics
NPI:1659350130
Name:ASHBY, BONNIE LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:BONNIE
Middle Name:LEE
Last Name:ASHBY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:933 E HAVERFORD RD
Mailing Address - Street 2:
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-3819
Mailing Address - Country:US
Mailing Address - Phone:610-520-5200
Mailing Address - Fax:610-520-1998
Practice Address - Street 1:933 E HAVERFORD RD
Practice Address - Street 2:
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-3819
Practice Address - Country:US
Practice Address - Phone:610-520-5200
Practice Address - Fax:610-520-1998
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2017-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-010909-E207RG0300X, 207RI0200X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
B38567Medicare UPIN
PA137478HK1Medicare PIN
PA232359401OtherMAIN LINE HEALTHCARE
B38567Medicare UPIN