Provider Demographics
NPI:1326326117
Name:BONDS, ERIC M (PAC)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:M
Last Name:BONDS
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 S 2ND ST STE 2F
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17104-1612
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:207 BLOOMING GROVE RD
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331-7917
Practice Address - Country:US
Practice Address - Phone:717-812-7559
Practice Address - Fax:717-632-2422
Is Sole Proprietor?:No
Enumeration Date:2011-07-27
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA054900363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1600950OtherGATEWAY MEDICARE ASSURED
PA2696609OtherHIGHMARK BLUE SHIELD - FREEDOM BLUE
PA239524FLTMedicare PIN
PA223825Medicare PIN
PAP01214302Medicare PIN