Healthcare Provider Details

I. General information

NPI: 1215315965
Provider Name (Legal Business Name): MARY ELIZABETH BONNET M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2015
Last Update Date: 05/15/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1870 WINTON RD S
ROCHESTER NY
14618-3960
US

IV. Provider business mailing address

1870 WINTON RD S
ROCHESTER NY
14618-3960
US

V. Phone/Fax

Practice location:
  • Phone: 585-784-8887
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number292307
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: