Provider Demographics
NPI:1083697072
Name:BONNER, ANTHONY J (MD)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:J
Last Name:BONNER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:908 NIAGARA FALLS BLVD
Mailing Address - Street 2:STE 208
Mailing Address - City:N TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14120-2019
Mailing Address - Country:US
Mailing Address - Phone:716-692-2160
Mailing Address - Fax:716-213-0348
Practice Address - Street 1:565 ABBOTT RD
Practice Address - Street 2:MERCY HOSPITAL
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14220-2039
Practice Address - Country:US
Practice Address - Phone:716-826-7000
Practice Address - Fax:716-213-0348
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-22
Last Update Date:2008-06-13
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Provider Licenses
StateLicense IDTaxonomies
NY104128207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00010019101OtherUNIVERA
NY000506757003OtherBLUE CROSS TRADITIONAL CO
NY1084844Medicaid
NY2100902OtherINDEPENDENT HEALTH
NY1084844Medicaid
NY2100902OtherINDEPENDENT HEALTH