Healthcare Provider Details

I. General information

NPI: 1730159732
Provider Name (Legal Business Name): BRIDGET STINE BONGAARD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2006
Last Update Date: 08/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 MEMORIAL BLVD
CONCORD NC
28025-2975
US

IV. Provider business mailing address

PO BOX 602344
CHARLOTTE NC
28260-2344
US

V. Phone/Fax

Practice location:
  • Phone: 704-403-7050
  • Fax: 704-403-7059
Mailing address:
  • Phone: 704-403-7050
  • Fax: 704-403-7059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number28133
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number28133
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: