MEDICARE: RICHARD H. BONDER 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	207N00000X	Dermatology Physician	CI-0000679	DE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0079504000	OTHER		AMERIHEALTH

General Provider Information

NPI Number	:	1932105194
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD H. BONDER M.D.

Provider Business Mailing Address
First Line	:	1941 LIMESTONE RD
Second Line	:	STE 202
City	:	WILMINGTON
State	:	DE
Zip	:	19808-5400
Country	:	US
Telephone Number	:	302-999-0075
Fax Number	:	302-995-0189

Provider Business Practice Location Address
First Line	:	1941 LIMESTONE RD
Second Line	:	STE 202
City	:	WILMINGTON
State	:	DE
Zip	:	19808-5400
Country	:	US
Telephone Number	:	302-999-0075
Fax Number	:	302-995-0189

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

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	07/08/2007

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Directions to “ RICHARD H. BONDER M.D.” Practice Location

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