MEDICARE: CHRISTL DANIELLE BONAPARTE PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	0110001743	VA
2	363AM0700X	Medical Physician Assistant	C0003486	MD

General Provider Information

NPI Number	:	1003807934
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTL DANIELLE BONAPARTE PA

Provider Business Mailing Address
First Line	:	12222 MCCULLAGH CT
Second Line	:
City	:	UPPER MARLBORO
State	:	MD
Zip	:	20772-5300
Country	:	US
Telephone Number	:	619-454-6707
Fax Number	:

Provider Business Practice Location Address
First Line	:	12222 MCCULLAGH CT
Second Line	:
City	:	UPPER MARLBORO
State	:	MD
Zip	:	20772-5300
Country	:	US
Telephone Number	:	619-454-6707
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/31/2005
Last Update Date	:	02/06/2019

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