Provider Demographics
NPI:1245357904
Name:BUCHANAN, BONNIE B (PA-C)
Entity type:Individual
Prefix:
First Name:BONNIE
Middle Name:B
Last Name:BUCHANAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:BONNIE
Other - Middle Name:BUCHANAN
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:785 5TH AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-4232
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2 KEEFER DR
Practice Address - Street 2:
Practice Address - City:MERCERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17236-1732
Practice Address - Country:US
Practice Address - Phone:717-328-2119
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA054782363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD103LM509OtherHIGHMARK PTAN
PA867633OtherMEDICARE GROUP #
PA103147321Medicaid
PA103147321Medicaid
PA367525LN7Medicare PIN
PA867633OtherMEDICARE GROUP #