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1578564209

NPI Code Detail

MEDICARE: JAMES JOSEPH BONNER MD

MEDICARE: JAMES JOSEPH BONNER 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	207V00000X	Obstetrics & Gynecology Physician	MD-031858-E	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	02337100	OTHER		CAPITAL BLUE CROSS
2	0991448	OTHER		KEYSTONEHEALTHPLANCENTRAL
3	249554	OTHER		MAMSI
4	01163701	OTHER		CAPITAL BLUE CROSS
5	B0128492	OTHER		HIGHMARK BLUE SHIELD
6	0027861	OTHER		AETNA
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578564209
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES JOSEPH BONNER MD

Provider Business Mailing Address
First Line	:	1940 N 13TH ST
Second Line	:	STE 207
City	:	READING
State	:	PA
Zip	:	19604-1539
Country	:	US
Telephone Number	:	610-921-9751
Fax Number	:	610-921-2681

Provider Business Practice Location Address
First Line	:	1940 N 13TH ST
Second Line	:	STE 207
City	:	READING
State	:	PA
Zip	:	19604-1539
Country	:	US
Telephone Number	:	610-921-9751
Fax Number	:	610-921-2681

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

Provider Enumeration Date	:	08/03/2005
Last Update Date	:	07/08/2007

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Directions to “ JAMES JOSEPH BONNER MD” Practice Location

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