MEDICARE: DR. PAULA A BONONI 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	207R00000X	Internal Medicine Physician	MD025970E	PA

General Provider Information

NPI Number	:	1215932777
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAULA A BONONI MD

Provider Business Mailing Address
First Line	:	500 OLD YORK RD
Second Line	:
City	:	JENKINTOWN
State	:	PA
Zip	:	19046-2852
Country	:	US
Telephone Number	:	215-886-0174
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 OLD YORK RD
Second Line	:
City	:	JENKINTOWN
State	:	PA
Zip	:	19046-2852
Country	:	US
Telephone Number	:	215-886-0174
Fax Number	:

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

Provider Enumeration Date	:	06/20/2005
Last Update Date	:	05/19/2022

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