Provider Demographics
NPI:1003878794
Name:BONYAK, EDWARD VINCENT (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:VINCENT
Last Name:BONYAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2410 ATHERHOLT RD
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24501-2148
Mailing Address - Country:US
Mailing Address - Phone:434-200-5252
Mailing Address - Fax:434-200-5252
Practice Address - Street 1:2410 ATHERHOLT RD
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-2148
Practice Address - Country:US
Practice Address - Phone:434-200-5252
Practice Address - Fax:434-200-5252
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101048188207RC0000X
WV20934207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
000875693OtherWV BLUE SHIELD - GROUP #
43935OtherSENTARA PROFESSIONAL
C00085OtherVA MEDICARE B - GROUP #
000486018OtherWV BLUE SHIELD
211032OtherANTHEM PROFESSIONAL
WV9371521OtherWV MEDICARE B - GROUP #
08251100000OtherQUALCHOICE
WV9371521OtherWV MEDICARE GRP NEW
P00656327OtherRAILROAD MEDICARE
2119629OtherMAMSI PROFESSIONAL
WV3810003817OtherWV MEDICAID GROUP
VA006051120Medicaid
WV0086502000Medicaid
MD550941600OtherMD MEDICAID GRP IN VA
WV9332051OtherWV MEDICARE B - GROUP #
WV9332051OtherWV MEDICARE GRP OLD
000875693OtherWV BLUE SHIELD - GROUP #
C00085OtherVA MEDICARE B - GROUP #
VA060000696Medicare PIN
WV4100823Medicare PIN
VAMC10498Medicare PIN
43935OtherSENTARA PROFESSIONAL
VA006051120Medicaid