Provider Demographics
NPI:1881137412
Name:BONANO, AMALIA MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:AMALIA
Middle Name:MARIE
Last Name:BONANO
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:PO BOX 864
Mailing Address - Street 2:
Mailing Address - City:FAJARDO
Mailing Address - State:PR
Mailing Address - Zip Code:00738-0864
Mailing Address - Country:US
Mailing Address - Phone:787-675-9913
Mailing Address - Fax:
Practice Address - Street 1:1757 ROCK QUARRY RD STE A
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-7303
Practice Address - Country:US
Practice Address - Phone:678-284-6575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-30
Last Update Date:2025-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA103822207RH0003X
PR19715207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine