Healthcare Provider Details

I. General information

NPI: 1912915786
Provider Name (Legal Business Name): MICHAEL BONIDIE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 02/05/2025
Certification Date: 02/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2025 TECHNOLOGY PKWY STE 108
MECHANICSBURG PA
17050-9401
US

IV. Provider business mailing address

2025 TECHNOLOGY PKWY STE 108
MECHANICSBURG PA
17050-9401
US

V. Phone/Fax

Practice location:
  • Phone: 717-791-2590
  • Fax: 717-221-5466
Mailing address:
  • Phone: 717-791-2590
  • Fax: 717-221-5466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License NumberMD064975L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD064975L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: