Provider Demographics
NPI:1336698497
Name:BONNEVILLE, CHRISTEL MERCADO (PA-C)
Entity Type:Individual
Prefix:
First Name:CHRISTEL
Middle Name:MERCADO
Last Name:BONNEVILLE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:PAULA CHRISTEL
Other - Middle Name:SANTOS
Other - Last Name:MERCADO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3700 TOONE ST APT 2675
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-5171
Mailing Address - Country:US
Mailing Address - Phone:410-967-1125
Mailing Address - Fax:
Practice Address - Street 1:2700 QUARRY LAKE DR STE 300
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21209-3746
Practice Address - Country:US
Practice Address - Phone:410-377-8900
Practice Address - Fax:410-377-0576
Is Sole Proprietor?:No
Enumeration Date:2016-09-29
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0006228363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant