Provider Demographics
NPI:1083917801
Name:BUONOMO MEDICAL ASSOCIATES INC.
Entity Type:Organization
Organization Name:BUONOMO MEDICAL ASSOCIATES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:BUONOMO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:215-483-8666
Mailing Address - Street 1:446 DOMINO LANE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19128
Mailing Address - Country:US
Mailing Address - Phone:215-483-8666
Mailing Address - Fax:215-483-9616
Practice Address - Street 1:446 DOMINO LANE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19128
Practice Address - Country:US
Practice Address - Phone:215-483-8666
Practice Address - Fax:215-483-9616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-16
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care