MEDICARE: SUSAN J BONA M. D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207ZD0900X	Dermatopathology (Pathology) Physician	35059562	OH
2	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	35059562	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	USE SSN-00	OTHER	OH	OHIO BWC
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	220023136	OTHER		RR MCR

General Provider Information

NPI Number	:	1164423430
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN J BONA M. D.

Provider Business Mailing Address
First Line	:	PO BOX 20452
Second Line	:	CORPATH CRED
City	:	COLUMBUS
State	:	OH
Zip	:	43220-0452
Country	:	US
Telephone Number	:	614-566-5526
Fax Number	:	614-442-2410

Provider Business Practice Location Address
First Line	:	3535 OLENTANGY RIVER RD
Second Line	:	RMH PATHOLOGY DEPT
City	:	COLUMBUS
State	:	OH
Zip	:	43214-3908
Country	:	US
Telephone Number	:	614-566-4945
Fax Number	:	614-263-1056

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	05/24/2013

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