MEDICARE: DR. VALERIE BONICA DO

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	207Q00000X	Family Medicine Physician	OT012330	PA

General Provider Information

NPI Number	:	1184885329
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VALERIE BONICA DO

Provider Business Mailing Address
First Line	:	321 W GIRARD AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19123-1531
Country	:	US
Telephone Number	:	215-685-3803
Fax Number	:	215-685-3816

Provider Business Practice Location Address
First Line	:	500 S BROAD ST
Second Line	:	3RD FLOOR
City	:	PHILADELPHIA
State	:	PA
Zip	:	19146-1613
Country	:	US
Telephone Number	:	215-685-6790
Fax Number	:	215-685-6732

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

Provider Enumeration Date	:	06/20/2008
Last Update Date	:	09/08/2011

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Directions to “ DR. VALERIE BONICA DO” Practice Location

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