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General NPI Number Information
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NPI Number | 1881354579
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Entity Type | Individual
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Provider Name | THOMAS ANTHONY BUONANNO PA-C
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Gender | Male
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Dates
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Enumeration Date | 12/22/2021
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Last Update Date | 12/22/2021
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Provider Practice Location Address
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Address Line | 1200 OLD YORK RD
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City | ABINGTON
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State | PA
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Zip | 19001-3720
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Country | US
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Telephone | 215-481-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 4215 MANAYUNK AVE APT D
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City | PHILADELPHIA
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State | PA
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Zip | 19128-5048
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Country | US
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Telephone | 484-809-5968
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Fax |
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | MA063003
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License Number State | PA
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