Provider Demographics
NPI:1164456877
Name:CATALANO, BONNIE W (DO)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:W
Last Name:CATALANO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2850 N RIDGE RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-3464
Mailing Address - Country:US
Mailing Address - Phone:410-465-8119
Mailing Address - Fax:410-203-2016
Practice Address - Street 1:2850 N RIDGE RD
Practice Address - Street 2:SUITE 103
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043-3464
Practice Address - Country:US
Practice Address - Phone:410-465-8119
Practice Address - Fax:410-203-2016
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH0040518207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDP00228704OtherMEDICARE RAILROAD
MD071921800Medicaid
MD006N840FMedicare PIN
MD071921800Medicaid
E86150Medicare UPIN