Healthcare Provider Details

I. General information

NPI: 1164423430
Provider Name (Legal Business Name): SUSAN J BONA M. D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 05/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3535 OLENTANGY RIVER RD RMH PATHOLOGY DEPT
COLUMBUS OH
43214-3908
US

IV. Provider business mailing address

PO BOX 20452 CORPATH CRED
COLUMBUS OH
43220-0452
US

V. Phone/Fax

Practice location:
  • Phone: 614-566-4945
  • Fax: 614-263-1056
Mailing address:
  • Phone: 614-566-5526
  • Fax: 614-442-2410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License Number35059562
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number35059562
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: