Provider Demographics
NPI:1003236787
Name:BONAKDAR, ROMIN
Entity Type:Individual
Prefix:
First Name:ROMIN
Middle Name:
Last Name:BONAKDAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4419 BEN FRANKLIN BLVD APT E308
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-2147
Mailing Address - Country:US
Mailing Address - Phone:919-477-3005
Mailing Address - Fax:919-477-5526
Practice Address - Street 1:4419 BEN FRANKLIN BLVD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-2147
Practice Address - Country:US
Practice Address - Phone:919-477-3005
Practice Address - Fax:919-477-5526
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-22
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201812390200000X
NC2017-00882207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program