1295750966 NPI number — DAVID DAMIAN BONACCI MD

Table of content: DAVID DAMIAN BONACCI MD (NPI 1295750966)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295750966 NPI number — DAVID DAMIAN BONACCI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BONACCI
Provider First Name:
DAVID
Provider Middle Name:
DAMIAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295750966
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/04/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
104 FOUR WINDS ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PETERBOROUGH
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03458
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-924-6484
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
36 CLINTON STREET
Provider Second Line Business Practice Location Address:
NEW HAMPSHIRE HOSPITAL
Provider Business Practice Location Address City Name:
CONCORD
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-271-5300
Provider Business Practice Location Address Fax Number:
603-271-5395
Provider Enumeration Date:
07/13/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  9180 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2084P0805X , with the licence number: 9180 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: B71809 . This identifiers is of the category "MEDICARE UPIN".