Healthcare Provider Details

I. General information

NPI: 1518207539
Provider Name (Legal Business Name): ERNEST O BONSU MS, PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2013
Last Update Date: 02/19/2025
Certification Date: 02/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8118 GOOD LUCK RD
LANHAM MD
20706-3574
US

IV. Provider business mailing address

PO BOX 418056
BOSTON MA
02241-8056
US

V. Phone/Fax

Practice location:
  • Phone: 301-552-8130
  • Fax:
Mailing address:
  • Phone: 301-552-8130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberC5-0000842
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC0004941
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: