MEDICARE: DR. GIOVANNI M. BONDS PH.D.

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	103TC0700X	Clinical Psychologist	3055	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538164256
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GIOVANNI M. BONDS PH.D.

Provider Business Mailing Address
First Line	:	529 W GRAND AVE
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45405-4408
Country	:	US
Telephone Number	:	937-277-7962
Fax Number	:	937-277-6067

Provider Business Practice Location Address
First Line	:	109 WHITE ALLEN AVE
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45405-4932
Country	:	US
Telephone Number	:	937-277-7962
Fax Number	:	937-277-6067

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

Provider Enumeration Date	:	06/17/2005
Last Update Date	:	12/05/2011

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