Provider Demographics
NPI:1386630796
Name:BONEY, ELLEN WEINBERG (MD)
Entity Type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:WEINBERG
Last Name:BONEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ELLEN
Other - Middle Name:JOHANNA
Other - Last Name:WEINBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6605 ABERCORN ST
Mailing Address - Street 2:SUITE108
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-5815
Mailing Address - Country:US
Mailing Address - Phone:912-355-7214
Mailing Address - Fax:
Practice Address - Street 1:6605 ABERCORN ST
Practice Address - Street 2:SUITE108
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-5815
Practice Address - Country:US
Practice Address - Phone:912-355-7214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-21
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA036480207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000664001DMedicaid
GA000664001DMedicaid
G06931Medicare UPIN