MEDICARE: DR. ARNULFO B BONAVENTE M.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	207Q00000X	Family Medicine Physician	D0045630	MD

General Provider Information

NPI Number	:	1619973534
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ARNULFO B BONAVENTE M.D.

Provider Business Mailing Address
First Line	:	10403 HOSPITAL DR
Second Line	:	STE G4
City	:	CLINTON
State	:	MD
Zip	:	20735-3137
Country	:	US
Telephone Number	:	301-856-3019
Fax Number	:	301-856-9370

Provider Business Practice Location Address
First Line	:	6409 CRAIN HWY
Second Line	:	ROUTE 301
City	:	UPPER MARLBORO
State	:	MD
Zip	:	20772-4139
Country	:	US
Telephone Number	:	301-952-8614
Fax Number	:	301-627-1603

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

Provider Enumeration Date	:	06/24/2005
Last Update Date	:	12/20/2016

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