1336193515 NPI number — MR. RICHARD PAUL BONFIGLIO M.D.

Table of content: MR. RICHARD PAUL BONFIGLIO M.D. (NPI 1336193515)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336193515 NPI number — MR. RICHARD PAUL BONFIGLIO M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BONFIGLIO
Provider First Name:
RICHARD
Provider Middle Name:
PAUL
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BONFIGLIO
Provider Other First Name:
RICHARD
Provider Other Middle Name:
P
Provider Other Name Prefix Text:
MR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1336193515
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/19/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 551
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MURRYSVILLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15668-0551
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-327-8255
Provider Business Mailing Address Fax Number:
724-325-2783

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5620 WILLIAM PENN HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MURRYSVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15632-9035
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-327-8255
Provider Business Practice Location Address Fax Number:
724-325-2783
Provider Enumeration Date:
05/20/2006

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: 208100000X , with the licence number:  MD-025969E , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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