Provider Demographics
NPI:1982643920
Name:BUSTIN, AMY M (PA-C)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:M
Last Name:BUSTIN
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:1015 CHESTNUT ST
Mailing Address - Street 2:SUITE 821
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-4316
Mailing Address - Country:US
Mailing Address - Phone:215-922-1801
Mailing Address - Fax:215-922-1806
Practice Address - Street 1:1015 CHESTNUT ST
Practice Address - Street 2:SUITE 821
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4316
Practice Address - Country:US
Practice Address - Phone:215-922-1801
Practice Address - Fax:215-922-1806
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2009-02-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMA051630363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q16689Medicare UPIN
079080D6QMedicare ID - Type Unspecified