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NPI Code Detail

MEDICARE: BONITA MRAS PA-C

MEDICARE: BONITA MRAS 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
1363AM0700XMedical Physician AssistantMA-001134-LPA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
4P00120630OTHERPARAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1019762OTHERPABLUE CARE
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
350076566OTHERPACAPITAL BLUE CROSS

General Provider Information

NPI Number : 1538154521
Entity Type Code : Individual
Provider Name (Legal Business Name) : BONITA MRAS PA-C
Provider Business Mailing Address
First Line : 150 MUNDY ST
Second Line :
City : WILKES BARRE
State : PA
Zip : 18702-6830
Country : US
Telephone Number : 570-824-0930
Fax Number : 570-824-7755
Provider Business Practice Location Address
First Line : 150 MUNDY ST
Second Line :
City : WILKES BARRE
State : PA
Zip : 18702-6830
Country : US
Telephone Number : 570-824-0930
Fax Number : 570-824-7755
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/15/2005
Last Update Date : 11/09/2016

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Directions to “ BONITA MRAS PA-C” Practice Location

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