1881629913 NPI number — DR. BERNARD J BONNER PHD

Table of content: DR. BERNARD J BONNER PHD (NPI 1881629913)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881629913 NPI number — DR. BERNARD J BONNER PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BONNER
Provider First Name:
BERNARD
Provider Middle Name:
J
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD
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:
1881629913
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1218 CHESTNUT STREET SUITE 607
Provider Second Line Business Mailing Address:
DR ROBIN LOWEY & ASSOCIATES
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19107
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-625-9655
Provider Business Mailing Address Fax Number:
215-625-8524

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1920 COTTMAN AVENUE
Provider Second Line Business Practice Location Address:
2ND FLOOR
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19111
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-625-9655
Provider Business Practice Location Address Fax Number:
215-625-8524
Provider Enumeration Date:
07/11/2006

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: 103T00000X , with the licence number:  PS007488L , 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)

  • Identifier: 27063900 . This is a "MAGELLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: B0793861 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com