Provider Demographics
NPI:1912015132
Name:BASHLINE, BRUCE STEWART (DO)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:STEWART
Last Name:BASHLINE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 SPRING GARDEN DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17057
Mailing Address - Country:US
Mailing Address - Phone:717-985-9091
Mailing Address - Fax:717-785-9094
Practice Address - Street 1:1100 SPRING GARDEN DR
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:PA
Practice Address - Zip Code:17057
Practice Address - Country:US
Practice Address - Phone:717-985-9091
Practice Address - Fax:717-785-9094
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA05-004607-L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
B41702Medicare UPIN
430449Q7TMedicare ID - Type Unspecified