MEDICARE: DR. TED C. BONAR PSYD

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	103T00000X	Psychologist	0810008839	VA
2	103T00000X	Psychologist	6971	OH

General Provider Information

NPI Number	:	1306148945
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TED C. BONAR PSYD

Provider Business Mailing Address
First Line	:	1533 OAK ST
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43205-2145
Country	:	US
Telephone Number	:	773-426-5147
Fax Number	:

Provider Business Practice Location Address
First Line	:	1533 OAK ST
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43205-2145
Country	:	US
Telephone Number	:	773-426-5147
Fax Number	:

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

Provider Enumeration Date	:	12/02/2010
Last Update Date	:	03/11/2025

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