Healthcare Provider Details

I. General information

NPI: 1629030697
Provider Name (Legal Business Name): BONNIE ZETLIN HARTE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 11/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 BLUERIDGE AVE
SILVER SPRING MD
20902-4517
US

IV. Provider business mailing address

9413 SPRUCE TREE CIR
BETHESDA MD
20814-1654
US

V. Phone/Fax

Practice location:
  • Phone: 301-933-6440
  • Fax: 301-933-5923
Mailing address:
  • Phone: 301-897-8445
  • Fax: 301-897-9147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0044280
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: