MEDICARE: MS. LAURIE HELEN BONCI PA-C

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	928	MA
2	363A00000X	Physician Assistant	PA9105275	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000051543	OTHER	MA	BMC HEALTHNET
2	000928	OTHER	MA	CONNECTICARE
3	1265402549	OTHER	MA	FALLON CHP
4	83-08485	OTHER	MA	EVERCARE
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265402549
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LAURIE HELEN BONCI PA-C

Provider Business Mailing Address
First Line	:	31 FOREST ST
Second Line	:
City	:	NEWTON HIGHLANDS
State	:	MA
Zip	:	02461-1445
Country	:	US
Telephone Number	:	617-916-1300
Fax Number	:	617-916-1300

Provider Business Practice Location Address
First Line	:	31 FOREST ST
Second Line	:
City	:	NEWTON HIGHLANDS
State	:	MA
Zip	:	02461-1445
Country	:	US
Telephone Number	:	617-916-1300
Fax Number	:	617-916-1300

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

Provider Enumeration Date	:	01/26/2006
Last Update Date	:	01/20/2016

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