Provider Demographics
NPI:1164429718
Name:BONASSO, CHRISTIAN L (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTIAN
Middle Name:L
Last Name:BONASSO
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 1:3525 OLENTANGY RIVER RD
Mailing Address - Street 2:SUITE 5310
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-3937
Mailing Address - Country:US
Mailing Address - Phone:614-263-7002
Mailing Address - Fax:614-267-6683
Practice Address - Street 1:3525 OLENTANGY RIVER RD
Practice Address - Street 2:SUITE 5310
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-3937
Practice Address - Country:US
Practice Address - Phone:614-263-7002
Practice Address - Fax:614-267-6683
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.072145207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH600286OtherUNITED HEALTH CARE
OH000000195076OtherANTHEM PIN
OH7624851003OtherCIGNA PIN
OH310874776035OtherCARESOURCE PIN
OH7895215OtherAETNA PIN
OH310874776007OtherTRICARE PIN
OH2109435Medicaid
KY64068844Medicaid
OHBO0868782Medicare PIN
OH7624851003OtherCIGNA PIN
KY64068844Medicaid
OH000000195076OtherANTHEM PIN
OH2109435Medicaid
OH4982480003Medicare NSC