Healthcare Provider Details

I. General information

NPI: 1477514834
Provider Name (Legal Business Name): BONNIE FOSTER STRAKA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 01/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3350 BERKMAR DRIVE
CHARLOTTESVILLE VA
22901
US

IV. Provider business mailing address

3350 BERKMAR DR
CHARLOTTESVILLE VA
22901-1491
US

V. Phone/Fax

Practice location:
  • Phone: 434-923-4651
  • Fax:
Mailing address:
  • Phone: 434-923-4651
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number0101042830
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number0101042830
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: