Provider Demographics
NPI:1144292905
Name:BONIDIE, MARIANNE R (MD)
Entity type:Individual
Prefix:DR
First Name:MARIANNE
Middle Name:R
Last Name:BONIDIE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 HIGBEE DR STE D206
Mailing Address - Street 2:
Mailing Address - City:BETHEL PARK
Mailing Address - State:PA
Mailing Address - Zip Code:15102-4200
Mailing Address - Country:US
Mailing Address - Phone:412-854-7140
Mailing Address - Fax:412-854-7142
Practice Address - Street 1:1000 HIGBEE DR STE D206
Practice Address - Street 2:
Practice Address - City:BETHEL PARK
Practice Address - State:PA
Practice Address - Zip Code:15102-4200
Practice Address - Country:US
Practice Address - Phone:412-854-7140
Practice Address - Fax:412-854-7142
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD064974L207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001764501Medicaid
030150Medicare PIN
PA001764501Medicaid
PA0017645010002Medicaid
PA030150R7RMedicare PIN