Provider Demographics
NPI:1164423430
Name:BONA, SUSAN J (M D)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:J
Last Name:BONA
Suffix:
Gender:F
Credentials:M D
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 20452
Mailing Address - Street 2:CORPATH CRED
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-0452
Mailing Address - Country:US
Mailing Address - Phone:614-566-5526
Mailing Address - Fax:614-442-2410
Practice Address - Street 1:3535 OLENTANGY RIVER RD
Practice Address - Street 2:RMH PATHOLOGY DEPT
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-3908
Practice Address - Country:US
Practice Address - Phone:614-566-4945
Practice Address - Fax:614-263-1056
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2013-05-24
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Provider Licenses
StateLicense IDTaxonomies
OH35059562207ZD0900X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHUSE SSN-00OtherOHIO BWC
OH0892280Medicaid
220023136OtherRR MCR
OH0892280Medicaid