Individual
CHRISTINE BASTL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3401 N BROAD ST, PHILADELPHIA, PA 19140-5103
(215) 707-4600
(215) 707-4034
Mailing address
2450 W HUNTING PARK AVE, PHILADELPHIA, PA 19129-1302
(215) 707-4600
(215) 707-4034
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
MD012957E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0006753090001
—
PA
Enumeration date
10/05/2005
Last updated
04/24/2018
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