MEDICARE: DR. JOHN ANTHONY BUONOCORE D.O.

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	207L00000X	Anesthesiology Physician	182693	NY
2	208VP0014X	Interventional Pain Medicine Physician	5101020847	MI
3	208VP0014X	Interventional Pain Medicine Physician	182693	NY
4	208VP0014X	Interventional Pain Medicine Physician	3411255	OH
5	207LP2900X	Pain Medicine (Anesthesiology) Physician	02004457A	IN

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1992801492
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN ANTHONY BUONOCORE D.O.

Provider Business Mailing Address
First Line	:	3005 E STATE BLVD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46805-4736
Country	:	US
Telephone Number	:	260-267-9498
Fax Number	:

Provider Business Practice Location Address
First Line	:	3005 E STATE BLVD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46805-4736
Country	:	US
Telephone Number	:	260-267-9498
Fax Number	:

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

Provider Enumeration Date	:	09/15/2006
Last Update Date	:	04/01/2024

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