MEDICARE: JOSE F. BONELLI, M.D.P.C.

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	173000000X	Legal Medicine	D0035055	MD

General Provider Information

NPI Number	:	1639486061
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOSE F. BONELLI, M.D.P.C.

Provider Business Mailing Address
First Line	:	8807 COLESVILLE RD
Second Line	:	5TH FLOOR
City	:	SILVER SPRING
State	:	MD
Zip	:	20910-4346
Country	:	US
Telephone Number	:	301-608-3833
Fax Number	:

Provider Business Practice Location Address
First Line	:	8807 COLESVILLE RD
Second Line	:	5TH FLOOR
City	:	SILVER SPRING
State	:	MD
Zip	:	20910-4346
Country	:	US
Telephone Number	:	301-608-3833
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JOSE F. BONELLI
Credential	:	M.D.
Telephone Number	:	301-608-3833

Provider Enumeration Date	:	09/07/2010
Last Update Date	:	09/07/2010

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