Provider Demographics
NPI:1730180308
Name:BONACORSI, THOMAS F (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:F
Last Name:BONACORSI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2550 MOSSIDE BLVD
Mailing Address - Street 2:SUITE 550
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146-3540
Mailing Address - Country:US
Mailing Address - Phone:412-942-0702
Mailing Address - Fax:412-281-2610
Practice Address - Street 1:2550 MOSSIDE BLVD
Practice Address - Street 2:SUITE 550
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-3540
Practice Address - Country:US
Practice Address - Phone:412-942-0702
Practice Address - Fax:412-281-2610
Is Sole Proprietor?:No
Enumeration Date:2005-08-04
Last Update Date:2014-05-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD040904L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001128638Medicaid
PA001128638Medicaid
PA187776Medicare PIN