Provider Demographics
NPI:1346269198
Name:BONSALL, ERIC KEITH (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:KEITH
Last Name:BONSALL
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 1:649 MCCORMICK RD
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17055-5962
Mailing Address - Country:US
Mailing Address - Phone:717-795-0915
Mailing Address - Fax:
Practice Address - Street 1:5A MEL RON CT
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:PA
Practice Address - Zip Code:17013-8414
Practice Address - Country:US
Practice Address - Phone:717-730-3481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD036799E2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAE55836Medicare UPIN
PA614506Medicare ID - Type Unspecified