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General NPI Number Information
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NPI Number | 1831271402
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Entity Type | Individual
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Provider Name | EUGENE VINCENT BONVENTRE MD
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Gender | Male
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Dates
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Enumeration Date | 10/20/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | PENTAGON FLIGHT MEDICINE CLINIC 1760 AIR FORCE PENTAGON ROOM 4A674
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City | WASHINGTON
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State | DC
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Zip | 20330-1760
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Country | US
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Telephone | 703-697-3255
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Fax | 703-614-1663
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Provider Business Mailing Address
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Address Line | 2109 12TH PL NW
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City | WASHINGTON
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State | DC
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Zip | 20009-7510
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Country | US
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Telephone | 703-697-0561
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Fax | 703-693-0729
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2083A0100X
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Taxonomy Name | Aerospace Medicine Physician
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License Number |
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State | IL
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