Provider Demographics
NPI:1346207321
Name:BONAMINIO, ANTHONY (MD)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:BONAMINIO
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 1:860 PINELAND RD
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:SC
Mailing Address - Zip Code:29379-9492
Mailing Address - Country:US
Mailing Address - Phone:864-426-2153
Mailing Address - Fax:864-427-0154
Practice Address - Street 1:101 E WOOD ST
Practice Address - Street 2:SRMC DEPT. INPATIENT MEDICINE
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-3040
Practice Address - Country:US
Practice Address - Phone:864-560-6294
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC 20902207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC189433OtherMEDCOST
SC20057403OtherSELECT HEALTH
NC89065VCMedicaid
SC209028Medicaid
SC576000934-097OtherTRICARE
SC189433OtherMEDCOST
SC20057403OtherSELECT HEALTH