MEDICARE: BRIAN K BONNER MD

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	207Q00000X	Family Medicine Physician	MD424481	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295718823
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN K BONNER MD

Provider Business Mailing Address
First Line	:	521 GREENFIELD AVE
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15207-1091
Country	:	US
Telephone Number	:	412-422-6500
Fax Number	:	412-422-4357

Provider Business Practice Location Address
First Line	:	521 GREENFIELD AVE
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15207-1091
Country	:	US
Telephone Number	:	412-422-6500
Fax Number	:	412-422-4357

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

Provider Enumeration Date	:	11/29/2005
Last Update Date	:	06/08/2017

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