Healthcare Provider Details

I. General information

NPI: 1578559373
Provider Name (Legal Business Name): ADOLPHUS SOLOMON BONAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 09/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2544 COURT DR SUITE A
GASTONIA NC
28054-3450
US

IV. Provider business mailing address

2544 COURT DR SUITE A
GASTONIA NC
28054-3450
US

V. Phone/Fax

Practice location:
  • Phone: 704-671-6400
  • Fax: 704-671-6449
Mailing address:
  • Phone: 704-671-6400
  • Fax: 704-671-6449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number200401176
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: