Provider Demographics
NPI: | 1154323723 |
---|---|
Name: | BONIN, MARC M (DO) |
Entity type: | Individual |
Prefix: | DR |
First Name: | MARC |
Middle Name: | M |
Last Name: | BONIN |
Suffix: | |
Gender: | M |
Credentials: | DO |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 601 MEMORY LN |
Mailing Address - Street 2: | |
Mailing Address - City: | YORK |
Mailing Address - State: | PA |
Mailing Address - Zip Code: | 17402-2231 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 717-851-1405 |
Mailing Address - Fax: | 717-851-6969 |
Practice Address - Street 1: | 111 S FRONT ST |
Practice Address - Street 2: | |
Practice Address - City: | HARRISBURG |
Practice Address - State: | PA |
Practice Address - Zip Code: | 17101 |
Practice Address - Country: | US |
Practice Address - Phone: | 717-988-0000 |
Practice Address - Fax: | 717-782-5716 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2005-08-12 |
Last Update Date: | 2025-02-26 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
PA | OS009340L | 207P00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207P00000X | Allopathic & Osteopathic Physicians | Emergency Medicine |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
PA | 814101 | Other | FIRST PRIORITY HEALTH |
PA | 930100738 | Other | RAILROAD MEDICARE |
PA | 001722501 | Medicaid | |
PA | 66490 | Other | BLUE SHIELD |
PA | 066490NUT | Medicare PIN | |
PA | 001722501 | Medicaid | |
PA | 930100738 | Other | RAILROAD MEDICARE |