Provider Demographics
NPI:1083983019
Name:BONSALL MANFREDI & ASSOC, P.C.
Entity Type:Organization
Organization Name:BONSALL MANFREDI & ASSOC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD CERTIFIED CHILD/ADOLESCENT PS
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:K
Authorized Official - Last Name:BONSALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:717-221-0711
Mailing Address - Street 1:5A MELRON COURT
Mailing Address - Street 2:
Mailing Address - City:CARLISLE
Mailing Address - State:PA
Mailing Address - Zip Code:17013
Mailing Address - Country:US
Mailing Address - Phone:717-221-0711
Mailing Address - Fax:717-221-0435
Practice Address - Street 1:2600 WOODLAWN STREET
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17111
Practice Address - Country:US
Practice Address - Phone:717-221-0711
Practice Address - Fax:717-221-0435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-20
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD036799E2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1210002Medicaid
E66836Medicare UPIN
614506Medicare PIN