Provider Demographics
NPI:1144479296
Name:BONITA, LOUIS B (MD)
Entity type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:B
Last Name:BONITA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:LOUIS
Other - Middle Name:B
Other - Last Name:BONITA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:527 SHOEMAKER AVE
Mailing Address - Street 2:
Mailing Address - City:WEST WYOMING
Mailing Address - State:PA
Mailing Address - Zip Code:18644-1212
Mailing Address - Country:US
Mailing Address - Phone:570-693-2760
Mailing Address - Fax:
Practice Address - Street 1:527 SHOEMAKER AVE
Practice Address - Street 2:
Practice Address - City:WEST WYOMING
Practice Address - State:PA
Practice Address - Zip Code:18644-1212
Practice Address - Country:US
Practice Address - Phone:570-693-2760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-13
Last Update Date:2008-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD0164943207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine