Provider Demographics
NPI:1548480585
Name:BONITATIBUS, PATRICIA JOAN (MD)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:JOAN
Last Name:BONITATIBUS
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 1:9 KENWOOD PL
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-6042
Mailing Address - Country:US
Mailing Address - Phone:304-243-1027
Mailing Address - Fax:
Practice Address - Street 1:400 WOODLAWN RD
Practice Address - Street 2:
Practice Address - City:ALIQUIPPA
Practice Address - State:PA
Practice Address - Zip Code:15001-5410
Practice Address - Country:US
Practice Address - Phone:724-857-9640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD419757207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine