Provider Demographics
NPI:1255331542
Name:BONEZZI, DANA M (MD)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:M
Last Name:BONEZZI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3727 FRIENDSVILLE RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-7131
Mailing Address - Country:US
Mailing Address - Phone:330-202-3444
Mailing Address - Fax:330-202-3435
Practice Address - Street 1:3727 FRIENDSVILLE RD
Practice Address - Street 2:SUITE 2
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-7131
Practice Address - Country:US
Practice Address - Phone:330-202-3444
Practice Address - Fax:330-202-3435
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35073190B207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2116114Medicaid
OHBO0886771Medicare ID - Type Unspecified
OH2116114Medicaid