Provider Demographics
NPI:1366471849
Name:BONADIES, JOHN ANTHONY (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ANTHONY
Last Name:BONADIES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2200 WHITNEY AVE STE 170
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-3694
Mailing Address - Country:US
Mailing Address - Phone:203-281-7000
Mailing Address - Fax:203-909-6782
Practice Address - Street 1:2200 WHITNEY AVE STE 170
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518-3694
Practice Address - Country:US
Practice Address - Phone:203-281-7000
Practice Address - Fax:203-909-6782
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT032008208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT007320085Medicaid
CT020001699Medicare PIN
CT007320085Medicaid
CTD400159977Medicare PIN