Healthcare Provider Details

I. General information

NPI: 1730592130
Provider Name (Legal Business Name): JOHN BONNEWELL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2014
Last Update Date: 12/18/2024
Certification Date: 12/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ELM AND CARLTON STREETS
BUFFALO NY
14263
US

IV. Provider business mailing address

ELM AND CARLTON ST
BUFFALO NY
14263-0001
US

V. Phone/Fax

Practice location:
  • Phone: 716-845-2300
  • Fax:
Mailing address:
  • Phone: 716-845-2300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License Number310867
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number310867
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: