Healthcare Provider Details

I. General information

NPI: 1265426035
Provider Name (Legal Business Name): ERIC M BONNEM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2005
Last Update Date: 07/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

87 MCGREGOR ST DARTMOUTH HITCHCOCK - HEMATOLOGY/ONCOLOGY
MANCHESTER NH
03102
US

IV. Provider business mailing address

87 MCGREGOR ST DARTMOUTH HITCHCOCK - HEMATOLOGY/ONCOLOGY
MANCHESTER NH
03102
US

V. Phone/Fax

Practice location:
  • Phone: 603-695-2500
  • Fax:
Mailing address:
  • Phone: 603-695-2500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number24083
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number9298
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: