Provider Demographics
NPI:1295791226
Name:KUSHNER, JONATHAN PAIGE (MD)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:PAIGE
Last Name:KUSHNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4340 CLYO RD STE 200
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45459-7000
Mailing Address - Country:US
Mailing Address - Phone:937-396-2602
Mailing Address - Fax:937-395-3682
Practice Address - Street 1:4340 CLYO RD STE 200
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45459
Practice Address - Country:US
Practice Address - Phone:937-534-7330
Practice Address - Fax:937-395-3682
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-081060207R00000X, 207RE0101X, 207RG0100X
VA0101042378207RG0100X
PAMD0487446C207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2333111Medicaid
KY64053499Medicaid
OH2333111Medicaid
OH460003606OtherRAIL ROAD MEDICARE
H61892Medicare UPIN
IN200380400Medicaid