MEDICARE: ANTHONY J BONNER MD

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	207RC0000X	Cardiovascular Disease Physician	104128	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00010019101	OTHER	NY	UNIVERA
2	000506757003	OTHER	NY	BLUE CROSS TRADITIONAL CO
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	2100902	OTHER	NY	INDEPENDENT HEALTH

General Provider Information

NPI Number	:	1083697072
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTHONY J BONNER MD

Provider Business Mailing Address
First Line	:	908 NIAGARA FALLS BLVD
Second Line	:	STE 208
City	:	N TONAWANDA
State	:	NY
Zip	:	14120-2019
Country	:	US
Telephone Number	:	716-692-2160
Fax Number	:	716-213-0348

Provider Business Practice Location Address
First Line	:	565 ABBOTT RD
Second Line	:	MERCY HOSPITAL
City	:	BUFFALO
State	:	NY
Zip	:	14220-2039
Country	:	US
Telephone Number	:	716-826-7000
Fax Number	:	716-213-0348

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

Provider Enumeration Date	:	11/22/2005
Last Update Date	:	06/13/2008

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